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Individual

ANTHONY J HATHAWAY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
1333 W LOMBARD ST, DAVENPORT, IA 52804-2101
(563) 323-9331
(563) 323-1967
Mailing address
1333 W LOMBARD ST, DAVENPORT, IA 52804-2101
(563) 323-9331
(563) 323-1967

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
07404
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1057968
IA
Enumeration date
02/08/2008
Last updated
02/08/2008
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