Provider Demographics
NPI:1821135823
Name:SOIYA, ZACHARY NICHOLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:NICHOLAS
Last Name:SOIYA
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 1:2515 CAPTIVA DR APT 10
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-5616
Mailing Address - Country:US
Mailing Address - Phone:708-337-6473
Mailing Address - Fax:
Practice Address - Street 1:3708 JENNINGS STATION RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-3500
Practice Address - Country:US
Practice Address - Phone:314-382-2000
Practice Address - Fax:314-382-2411
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-178941223G0001X
MO2019038311122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice