Provider Demographics
NPI:1932124104
Name:ZALUCKY, MYRON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MYRON
Middle Name:
Last Name:ZALUCKY
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 1:9003 UPPER HAVENSIGHT MALL
Mailing Address - Street 2:SUITE #309
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-2666
Mailing Address - Country:US
Mailing Address - Phone:340-776-5050
Mailing Address - Fax:340-777-9170
Practice Address - Street 1:9003 UPPER HAVENSIGHT MALL
Practice Address - Street 2:SUITE #309
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2666
Practice Address - Country:US
Practice Address - Phone:340-776-5050
Practice Address - Fax:340-777-9170
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI557122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist