Provider Demographics
NPI:1447698451
Name:DAHL, EVA C (DDS)
Entity type:Individual
Prefix:DR
First Name:EVA
Middle Name:C
Last Name:DAHL
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 1:2700 NATIONAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-6708
Mailing Address - Country:US
Mailing Address - Phone:608-783-3636
Mailing Address - Fax:608-783-3639
Practice Address - Street 1:2700 NATIONAL DR STE 1
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-6708
Practice Address - Country:US
Practice Address - Phone:608-783-3636
Practice Address - Fax:608-783-3639
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001745-0151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics