Provider Demographics
NPI:1255985289
Name:EADES, ZACKERY ETHAN (DMD)
Entity type:Individual
Prefix:
First Name:ZACKERY
Middle Name:ETHAN
Last Name:EADES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-0248
Mailing Address - Country:US
Mailing Address - Phone:334-566-8266
Mailing Address - Fax:
Practice Address - Street 1:98 OAK PARK DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36079-3085
Practice Address - Country:US
Practice Address - Phone:205-913-1969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0006649-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist