DR. Evan Hathaway, DDS

NPI #1033455019 in Eagle, Idaho

Provider Information

NPI Number: 1033455019
Entity Type: Individual
Name: DR. Evan Hathaway, DDS
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist
Credential: DDS
Enumeration Date: Dec 20, 2012
Last Updated: Dec 20, 2012

Practice Location

Address: 1217 E IRON EAGLE DR
City: Eagle
State: Idaho
ZIP Code: 83616-6599
Phone: (208) 377-1161

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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