Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | D-4215 | ID |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 21339 | MT |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 35685 | TX |
N | 1223S0112X | Oral and Maxillofacial Surgeon | D-4215-OS | ID |
NPI | 1083846133 |
---|---|
Provider Name | Dr. Derrick Zech |
First Address | Great Falls, MT 59405-5169 |
Second Address | Great Falls, MT 59405-5169 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2009 |
Last Update Date | 26/01/2022 |