Provider Demographics
NPI:1376291138
Name:MZ TMD AND ZZZ LLC
Entity Type:Organization
Organization Name:MZ TMD AND ZZZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZYK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-390-9991
Mailing Address - Street 1:560 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4535
Mailing Address - Country:US
Mailing Address - Phone:636-390-9991
Mailing Address - Fax:636-390-9985
Practice Address - Street 1:560 E 14TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4535
Practice Address - Country:US
Practice Address - Phone:636-390-9991
Practice Address - Fax:636-390-9985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty