Healthcare Provider Details

I. General information

NPI: 1205141579
Provider Name (Legal Business Name): GREGORY SHAYNE ZILINSKI D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 01/04/2022
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 FT RICHARDSON AVE 17TH MEDICAL GROUP
GOODFELLOW AFB TX
76908
US

IV. Provider business mailing address

271 FT RICHARDSON AVE
GOODFELLOW TX
76908
US

V. Phone/Fax

Practice location:
  • Phone: 325-654-3053
  • Fax:
Mailing address:
  • Phone: 325-654-3053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901020253
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901020253
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: