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General NPI Number Information
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NPI Number | 1275429383
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Entity Type | Organization
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Legal Business Name | AUTAUGA STATION DENTAL
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 1803 STATION DR STE A
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City | PRATTVILLE
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State | AL
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Zip | 36066-5671
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Country | US
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Telephone | 334-361-9880
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Fax |
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Provider Business Mailing Address
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Address Line | 1803 STATION DR STE A
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City | PRATTVILLE
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State | AL
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Zip | 36066-5671
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Country | US
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Telephone | 334-361-9880
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. ZACKERY ETHAN EADES
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Credential | DMD
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Telephone | 205-913-1969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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