| NPI | 1851552194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVAN WAYNE HATHAWAY Owner Pres Corporation 208-378-9704 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D2040) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2008-06-19 |