Randy S. Hathorn D.m.d
Randy S. Hathorn D.m.d is a health care provider in Bassfield, MS. In this page you will find its mailing address, practice location, phone number, specialty etc.
|Practice Location|| 218 Gen Robert E Blount, A, Bassfield, MS 39421-0549, US |
|Practice Location Phone||601-943-5126|
|Practice Location Fax||601-943-6143|
|Legal Business Name||RANDY S. HATHORN D.M.D|
|Enumeration Date ? ||Dec 28, 2007|
|Last Update Date ? ||Dec 28, 2007|
NPI: National Provider Identifier issued to health care providers by Centers for Medicare and Medicaid Services (CMS).
Specialties & Licenses of Randy S. Hathorn D.m.d
|Specialty||Provider Type||Specialization||License||License State|
|Dentist||Dental Providers|| ||2016-83||Mississippi|
|Dentist||Dental Providers|| ||3361-05||Mississippi|
Legacy Provider IDs of Randy S. Hathorn D.m.d
|Provider Id||Issuer State||Issuer Type||Issuer|
Authorized Official of Randy S. Hathorn D.m.d
An authorized official is an appointed official with the legal authority to make changes and/or updates to the Randy S. Hathorn D.m.d's status and to commit the provider to fully abide by the laws and regulations relating to the National Provider Identifier (NPI).
|Authorized Official || Randy S Hathorn (D.M.D.)|
|Authorized Official Title/Position||OWNER|
|Authorized Official Phone Number||601-943-5126|