Provider Demographics
NPI:1275429383
Name:AUTAUGA FAMILY DENTAL
Entity type:Organization
Organization Name:AUTAUGA FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACKERY
Authorized Official - Middle Name:ETHAN
Authorized Official - Last Name:EADES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-913-1969
Mailing Address - Street 1:1803 STATION DR STE A
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-5671
Mailing Address - Country:US
Mailing Address - Phone:334-361-9880
Mailing Address - Fax:
Practice Address - Street 1:1803 STATION DR STE A
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-5671
Practice Address - Country:US
Practice Address - Phone:334-361-9880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental