Mazen Y Sultan, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

9620 Issued in KY

Practice address

4133 Mexico Road
St. Peters, MO 63376

Phone

(636) 447-6060

Fax

(636) 447-2428

NPI assigned

Mar 23, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639353600000",
    "number": "1093109571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4133 MEXICO ROAD",
            "city": "ST. PETERS",
            "state": "MO",
            "postal_code": "63376",
            "telephone_number": "636-447-6060",
            "fax_number": "636-447-2428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4133 MEXICO ROAD",
            "city": "ST. PETERS",
            "state": "MO",
            "postal_code": "63376",
            "telephone_number": "636-447-6060",
            "fax_number": "636-447-2428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULTAN",
        "first_name": "MAZEN",
        "middle_name": "Y",
        "name_prefix": "Mr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-23",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "9620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Robert Sturges, D.C.
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• Julie L Subbert, R.N.
• Amy Marie Sullivan, MOT, OTR/L
• Ramez Sunna
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• Terry Aurthur Surtin, D.C.
• Andrew John Susuki, DMD

• Dentist in St. Peters, MO
• Providers in St. Peters, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.