Provider Demographics
NPI:1720439094
Name:DOTHEROW, SETH DEAN (DMD)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:DEAN
Last Name:DOTHEROW
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 1:105 BELLE MEADE PT
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-3309
Mailing Address - Country:US
Mailing Address - Phone:601-919-8575
Mailing Address - Fax:601-919-8577
Practice Address - Street 1:105 BELLE MEADE PT
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-3309
Practice Address - Country:US
Practice Address - Phone:601-919-8575
Practice Address - Fax:601-919-8577
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3865-161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice