Provider Demographics
NPI:1356351993
Name:AKERS, DOUGLAS B
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:B
Last Name:AKERS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DOUGLAS
Other - Middle Name:B
Other - Last Name:AKERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:716 YELLOWSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4407
Mailing Address - Country:US
Mailing Address - Phone:208-233-3660
Mailing Address - Fax:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD1738PE1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0035491Medicaid