Provider Demographics
NPI:1124180088
Name:ZLOCK, GREGORY ALLAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALLAN
Last Name:ZLOCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 S RESERVE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3101
Mailing Address - Country:US
Mailing Address - Phone:406-543-6320
Mailing Address - Fax:406-541-6307
Practice Address - Street 1:1211 S RESERVE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3101
Practice Address - Country:US
Practice Address - Phone:406-543-6320
Practice Address - Fax:406-541-6307
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0130000Medicaid
MT5512923OtherCHIP