Individual
DR. EVAN HATHAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1217 E IRON EAGLE DR, EAGLE, ID 83616-6599
(208) 377-1161
(208) 938-0567
Mailing address
1217 E IRON EAGLE DR, EAGLE, ID 83616-6599
(208) 377-1161
(208) 938-0567
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D2040
ID
Other
Enumeration date
12/20/2012
Last updated
12/20/2012
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