Provider Demographics
NPI:1740412550
Name:S. ZAK HALLOCK, DMD, INC
Entity Type:Organization
Organization Name:S. ZAK HALLOCK, DMD, INC
Other - Org Name:WILMINGTON FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:S.
Authorized Official - Middle Name:ZAK
Authorized Official - Last Name:HALLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:216-536-9652
Mailing Address - Street 1:2440 WILMINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-2459
Mailing Address - Country:US
Mailing Address - Phone:937-296-9672
Mailing Address - Fax:866-682-5140
Practice Address - Street 1:2440 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-2459
Practice Address - Country:US
Practice Address - Phone:937-296-9672
Practice Address - Fax:866-682-5140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.022787122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty