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General NPI Number Information
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NPI Number | 1245324391
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Entity Type | Organization
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Legal Business Name | DOUGLAS B AKERS,DDS,MS,PLLC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 716 YELLOWSTONE AVE
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City | POCATELLO
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State | ID
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Zip | 83201-4407
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Country | US
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Telephone | 208-233-3660
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Fax | 208-233-3682
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Provider Business Mailing Address
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Address Line | 2009 SUNRISE WAY
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City | POCATELLO
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State | ID
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Zip | 83201-1985
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Country | US
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Telephone | 208-233-3660
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Fax | 208-233-3682
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DR. DOUGLAS B AKERS
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Credential | DDS,MS
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Telephone | 208-233-3660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | D1738PE
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License Number State | ID
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