Provider Demographics
NPI:1407915655
Name:EDWIN M. WHITE AND THOMAS W. HATHORN, A PROFESSIONAL DENTAL CORP.
Entity Type:Organization
Organization Name:EDWIN M. WHITE AND THOMAS W. HATHORN, A PROFESSIONAL DENTAL CORP.
Other - Org Name:WHITE & HATHORN DENTAL CORP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HATHORN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-448-3804
Mailing Address - Street 1:402 PINEGROVE DR
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-5726
Mailing Address - Country:US
Mailing Address - Phone:318-448-3804
Mailing Address - Fax:318-448-4880
Practice Address - Street 1:402 PINEGROVE DR
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-5726
Practice Address - Country:US
Practice Address - Phone:318-448-3804
Practice Address - Fax:318-448-4880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA31541223G0001X
LA55761223G0001X
LA27751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty