Evan Hathaway DDS PA

NPI #1851552194 in Eagle, Idaho

Provider Information

NPI Number: 1851552194
Entity Type: Organization
Organization Name: Evan Hathaway DDS PA
Primary Specialty: Dentist
Enumeration Date: Jun 19, 2008
Last Updated: Jun 19, 2008

Practice Location

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

Authorized Official

Name: EVAN WAYNE HATHAWAY, DDS
Title: OWNER PRES CORPORATION
Phone: (208) 378-9704

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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