Organization
RANDY S. HATHORN D.M.D
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY S HATHORN D.M.D. (OWNER)
(601) 943-5126
Entity
Organization
Contact information
Practice address
218 GEN ROBERT E BLOUNT, A, BASSFIELD, MS 39421-0549
(601) 943-5126
(601) 943-6143
Mailing address
PO BOX 549, BASSFIELD, MS 39421-0549
(601) 943-5126
(601) 943-6143
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2016-83
MS
122300000X
Dentist
3361-05
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03556870
—
MS
Enumeration date
12/28/2007
Last updated
12/28/2007
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