Healthcare Provider Details

I. General information

NPI: 1003782152
Provider Name (Legal Business Name): ZACHARY P EHRMANTROUT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6889 S EASTERN AVE STE 100A
LAS VEGAS NV
89119-4687
US

IV. Provider business mailing address

3233 36TH AVE NW
OLYMPIA WA
98502-3570
US

V. Phone/Fax

Practice location:
  • Phone: 360-250-9402
  • Fax:
Mailing address:
  • Phone: 360-250-9402
  • Fax: 360-250-9402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY EHRMANTROUT
Title or Position: ORTHODONTIST MEMBER
Credential: DDS
Phone: 360-250-9402