Healthcare Provider Details

I. General information

NPI: 1568729812
Provider Name (Legal Business Name): EVON HEASER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EVON HEASER DDS

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 NUCLEUS AVE
COLUMBIA FALLS MT
59912-4010
US

IV. Provider business mailing address

160 NUCLEUS AVE PO BOX 2065
COLUMBIA FALLS MT
59912-4010
US

V. Phone/Fax

Practice location:
  • Phone: 406-892-2085
  • Fax:
Mailing address:
  • Phone: 406-892-2085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD9762
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11380
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: