Provider Demographics
NPI:1245324391
Name:DOUGLAS B AKERS,DDS,MS,PLLC
Entity type:Organization
Organization Name:DOUGLAS B AKERS,DDS,MS,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:AKERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:208-233-3660
Mailing Address - Street 1:2009 SUNRISE WAY
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-1985
Mailing Address - Country:US
Mailing Address - Phone:208-233-3660
Mailing Address - Fax:208-233-3682
Practice Address - Street 1:716 YELLOWSTONE AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4407
Practice Address - Country:US
Practice Address - Phone:208-233-3660
Practice Address - Fax:208-233-3682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD1738PE1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0035491000Medicaid
ID=========Medicare UPIN