Provider Demographics
NPI:1487879292
Name:HAWS, ANNELIESE TAYLOR (DDS)
Entity type:Individual
Prefix:DR
First Name:ANNELIESE
Middle Name:TAYLOR
Last Name:HAWS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 S IRON SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-1973
Mailing Address - Country:US
Mailing Address - Phone:614-506-8579
Mailing Address - Fax:
Practice Address - Street 1:150 2ND ST
Practice Address - Street 2:
Practice Address - City:MELBA
Practice Address - State:ID
Practice Address - Zip Code:83641-5199
Practice Address - Country:US
Practice Address - Phone:208-495-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022307122300000X
IDD-4059122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist