| Paul Ivan Hathorn, DMD | |
|
1101 Highway 11 S, Ellisville, MS 39437-4443 | |
| (601) 477-5792 | |
| (601) 477-5782 |
| Full Name | Paul Ivan Hathorn |
|---|---|
| Gender | Male |
| Speciality | Dentist |
| Location | 1101 Highway 11 S, Ellisville, Mississippi |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225130040 | NPI | - | NPPES |
| 00060323 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2342-87 (Mississippi) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Paul Ivan Hathorn, DMD 1101 Highway 11 S, Ellisville, MS 39437-4443 Ph: (601) 477-5792 | Paul Ivan Hathorn, DMD 1101 Highway 11 S, Ellisville, MS 39437-4443 Ph: (601) 477-5792 |
Dr. Alecia A Moore, DMD Dentist Medicare: Not Enrolled in Medicare Practice Location: 97 Hal Crocker Rd, Ellisville, MS 39437 Phone: 601-477-3779 | |
Stephen L Surber, DMD Dentist Medicare: Medicare Enrolled Practice Location: 401 Highway 11 S, Ellisville, MS 39437 Phone: 601-477-3771 Fax: 601-477-3747 |