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Individual

RANDY S HATHORN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
218 A GEN ROBERT E BLOUNT DR, BASSFIELD, MS 39421-0549
(601) 943-5426
(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
1223G0001X
General Practice Dentistry
Primary
2016 83
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00060050
MS
Enumeration date
08/31/2006
Last updated
07/08/2007
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