Evan Hathaway DDS PA

NPI #1215016548 in Boise, Idaho

Provider Information

NPI Number: 1215016548
Entity Type: Organization
Organization Name: Evan Hathaway DDS PA
Primary Specialty: Dentist
Enumeration Date: Nov 6, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 7677 EMERALD ST
City: Boise
State: Idaho
ZIP Code: 83704
Phone: (208) 377-1161

Authorized Official

Name: EVAN WAYNE HATHAWAY, DDS
Title: PRESIDENT
Phone: (208) 377-1161

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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