Provider Demographics
NPI:1194961607
Name:HATHORN & LOCKE GENERAL DENTISTRY, LLC
Entity type:Organization
Organization Name:HATHORN & LOCKE GENERAL DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
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:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3154122300000X
LA5576122300000X
LA2775122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty