Provider Demographics
NPI:1083846133
Name:ZECH, DERRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:
Last Name:ZECH
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 1:2511 BOBCAT WAY
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5169
Mailing Address - Country:US
Mailing Address - Phone:406-727-4322
Mailing Address - Fax:406-771-1516
Practice Address - Street 1:2511 BOBCAT WAY
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5169
Practice Address - Country:US
Practice Address - Phone:406-727-4322
Practice Address - Fax:406-771-1516
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX356851223S0112X
MT213391223S0112X
IDD-4215122300000X
IDD-4215-OS1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist