Provider Demographics
NPI:1427188960
Name:ZUCK, GARY DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DEAN
Last Name:ZUCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8132 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-5008
Mailing Address - Country:US
Mailing Address - Phone:913-648-5261
Mailing Address - Fax:
Practice Address - Street 1:8132 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5008
Practice Address - Country:US
Practice Address - Phone:913-648-5261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS45701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice