Individual
PAUL IVAN HATHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1101 HIGHWAY 11 S, ELLISVILLE, MS 39437-4443
(601) 477-5792
(601) 477-5782
Mailing address
1101 HIGHWAY 11 S, ELLISVILLE, MS 39437-4443
(601) 477-5792
(601) 477-5782
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2342-87
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00060323
—
MS
Enumeration date
09/02/2006
Last updated
07/08/2007
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