Provider Demographics
NPI:1568729812
Name:HEASER, EVON (DDS)
Entity Type:Individual
Prefix:
First Name:EVON
Middle Name:
Last Name:HEASER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:EVON
Other - Middle Name:
Other - Last Name:HEASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:456 W SUNNYVIEW DR
Mailing Address - Street 2:APT #5
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-3892
Mailing Address - Country:US
Mailing Address - Phone:414-313-0359
Mailing Address - Fax:
Practice Address - Street 1:456 W SUNNYVIEW DR
Practice Address - Street 2:APT #5
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-3892
Practice Address - Country:US
Practice Address - Phone:414-313-0359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9762122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist