MEDICARE: DR. DERRICK ZECH D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	35685	TX
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	21339	MT
3	122300000X	Dentist	D-4215	ID
4	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	D-4215-OS	ID

General Provider Information

NPI Number	:	1083846133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DERRICK ZECH D.D.S.

Provider Business Mailing Address
First Line	:	2511 BOBCAT WAY
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-5169
Country	:	US
Telephone Number	:	406-727-4322
Fax Number	:	406-771-1516

Provider Business Practice Location Address
First Line	:	2511 BOBCAT WAY
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-5169
Country	:	US
Telephone Number	:	406-727-4322
Fax Number	:	406-771-1516

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2009
Last Update Date	:	01/26/2022

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