Provider Demographics
NPI:1962723957
Name:ZUKER, ETHAN DANIEL (DMD)
Entity type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:DANIEL
Last Name:ZUKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 W DESCHUTES PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7719
Mailing Address - Country:US
Mailing Address - Phone:509-783-1960
Mailing Address - Fax:
Practice Address - Street 1:7501 W DESCHUTES PL
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7719
Practice Address - Country:US
Practice Address - Phone:509-783-1960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011485A122300000X
WADE60273197122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist