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General NPI Number Information
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NPI Number | 1558484378
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Entity Type | Organization
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Legal Business Name | HATHAWAY FAMILY DENTISTRY, P.A.
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Dates
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Enumeration Date | 04/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8426 DOLLARWAY RD
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City | WHITE HALL
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State | AR
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Zip | 71602-2811
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Country | US
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Telephone | 501-626-1830
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Fax |
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Provider Business Mailing Address
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Address Line | 8426 DOLLARWAY RD
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City | WHITE HALL
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State | AR
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Zip | 71602-2811
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Country | US
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Telephone | 501-626-1830
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRADLEY WYATT HATHAWAY
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Credential | D.D.S.
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Telephone | 501-626-1830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3471
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License Number State | AR
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