Provider Demographics
NPI:1801420492
Name:ETHAN AKE DENTAL PLLC
Entity Type:Organization
Organization Name:ETHAN AKE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:AKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-225-0113
Mailing Address - Street 1:7924 CANTRELL RD STE B
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-2501
Mailing Address - Country:US
Mailing Address - Phone:501-225-0113
Mailing Address - Fax:501-225-0155
Practice Address - Street 1:7924 CANTRELL RD STE B
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-2501
Practice Address - Country:US
Practice Address - Phone:501-225-0113
Practice Address - Fax:501-225-0155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental