MEDICARE: DR. TERRY GENE ZUCUSKIE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4449	AZ

General Provider Information

NPI Number	:	1750373734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY GENE ZUCUSKIE D.D.S.

Provider Business Mailing Address
First Line	:	13000 N 103RD AVE
Second Line	:	SUITE 62
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3024
Country	:	US
Telephone Number	:	623-974-4888
Fax Number	:	623-974-4889

Provider Business Practice Location Address
First Line	:	13000 N 103RD AVE
Second Line	:	SUITE 62
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3024
Country	:	US
Telephone Number	:	623-974-4888
Fax Number	:	623-974-4889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	03/04/2008

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