Organization
EVAN HATHAWAY DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVAN WAYNE HATHAWAY DDS (OWNER PRES CORPORATION)
(208) 378-9704
Entity
Organization
Contact information
Practice address
1217 E IRON EAGLE DR, EAGLE, ID 83616
(208) 377-1161
(208) 938-0567
Mailing address
1217 E IRON EAGLE DR, EAGLE, ID 83616
(208) 377-1161
(208) 938-0567
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D2040
ID
Other
Enumeration date
06/19/2008
Last updated
06/19/2008
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