Provider Demographics
NPI:1750736609
Name:EVON T. HEASER, D.D.S., P.C.
Entity type:Organization
Organization Name:EVON T. HEASER, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVON
Authorized Official - Middle Name:T
Authorized Official - Last Name:HEASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-313-0359
Mailing Address - Street 1:4049 BAILEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-6256
Mailing Address - Country:US
Mailing Address - Phone:406-892-2085
Mailing Address - Fax:
Practice Address - Street 1:160 NUCLEUS AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912-4010
Practice Address - Country:US
Practice Address - Phone:406-892-2085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty