Provider Demographics
NPI:1598147449
Name:HATHEWAY, DAVID ALDEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALDEN
Last Name:HATHEWAY
Suffix:
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 1:230 E 10TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5784
Mailing Address - Country:US
Mailing Address - Phone:256-741-7340
Mailing Address - Fax:
Practice Address - Street 1:5412 MONTGOMERY HWY STE 8
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1657
Practice Address - Country:US
Practice Address - Phone:334-983-1730
Practice Address - Fax:334-983-1725
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL61971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice