Provider Demographics
NPI:1295865269
Name:RATHER, EDWARD JR (DMD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:RATHER
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 GOODMAN RD E
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9540
Mailing Address - Country:US
Mailing Address - Phone:662-349-0089
Mailing Address - Fax:662-349-4449
Practice Address - Street 1:1228 GOODMAN RD E
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9540
Practice Address - Country:US
Practice Address - Phone:662-349-0089
Practice Address - Fax:662-349-4449
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2506-891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice