Healthcare Provider Details

I. General information

NPI: 1962723957
Provider Name (Legal Business Name): ETHAN DANIEL ZUKER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 W DESCHUTES PL
KENNEWICK WA
99336-7719
US

IV. Provider business mailing address

7501 W DESCHUTES PL
KENNEWICK WA
99336-7719
US

V. Phone/Fax

Practice location:
  • Phone: 509-783-1960
  • Fax:
Mailing address:
  • Phone: 509-783-1960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12011485A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60273197
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: