Provider Demographics
NPI:1639263460
Name:MARK R ZUST DDS LTD
Entity Type:Organization
Organization Name:MARK R ZUST DDS LTD
Other - Org Name:FAMILY DENTISTRY OF ST. PETERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZUST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-928-1100
Mailing Address - Street 1:36 4 SEASONS SHOPPING CTR # 300
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3103
Mailing Address - Country:US
Mailing Address - Phone:636-928-1100
Mailing Address - Fax:636-928-1292
Practice Address - Street 1:80 GAILWOOD DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6581
Practice Address - Country:US
Practice Address - Phone:636-928-1100
Practice Address - Fax:636-928-1292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO121231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty