Provider Demographics
NPI:1518315985
Name:DAVID HATHEWAY DMD LLC
Entity Type:Organization
Organization Name:DAVID HATHEWAY DMD LLC
Other - Org Name:CENTRAL BALDWIN DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST /OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:HATHEWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-947-5940
Mailing Address - Street 1:18100 HWY 104
Mailing Address - Street 2:18100 HWY 104
Mailing Address - City:ROBERTSDALE
Mailing Address - State:AL
Mailing Address - Zip Code:36567
Mailing Address - Country:US
Mailing Address - Phone:251-947-5940
Mailing Address - Fax:
Practice Address - Street 1:18100 HWY 104
Practice Address - Street 2:18100 HWY 104
Practice Address - City:ROBERTSDALE
Practice Address - State:AL
Practice Address - Zip Code:36567
Practice Address - Country:US
Practice Address - Phone:251-947-5940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL61971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty