Evan Hathaway, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D2040 Issued in ID

Practice address

1217 E Iron Eagle Dr
Eagle, ID 83616-6599

Phone

(208) 377-1161

Fax

(208) 938-0567

NPI assigned

Dec 20, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1355961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355961600000",
    "number": "1033455019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1217 E IRON EAGLE DR",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166599",
            "telephone_number": "208-377-1161",
            "fax_number": "208-938-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1217 E IRON EAGLE DR",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166599",
            "telephone_number": "208-377-1161",
            "fax_number": "208-938-0567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATHAWAY",
        "first_name": "EVAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-12-20",
        "last_updated": "2012-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D2040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Happy Valley Healthcare LLC
• Matthew Hargis, RN
• Rachel Harrington
• Michele Harris, LCPC, M.ED
• Hathaway and Pelletier Family Dental PLLC
• Kaitlyndawn Haynes
• Health Services Seattle LLC
• Healthy Alignment Chiropractic PLLC
• Ryan Heilman, DPT
• Adam Heiner, O.D.

• Dentist in Eagle, ID
• Providers in Eagle, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.