Paul Ivan Hathorn is a Ellisville, Mississippi based Dentist who is specialized in
Dentistry. He does not accept the Medicare-approved amount. Patients will be billed for the treatment. Active license number of Paul Ivan Hathorn is
2342-87 for Dentistry in Mississippi. His current practice location is
1101 Highway 11 S, Ellisville. Patients can reach him at
601-477-5792.
Paul Ivan Hathorn is the primary dental care provider for patients of all ages. He is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Complete Profile:
Paul Ivan Hathorn speciality, credentials, practice address, contact phone number and fax are as below.
Patients can directly walk in or can call on the below given phone number for appointment.
| Name: | Paul Ivan Hathorn |
| Specialization: | Dentist |
| Gender: | Male |
| Credentials: | D.M.D. |
| Accepts Medicare Assignment: | No |
| Practice Address: | 1101 Highway 11 S, Ellisville,
Mississippi, 39437-4443 |
| Phone: | 601-477-5792 |
| Fax: | 601-477-5782 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details are as mentioned below.
| NPI Number: | 1225130040 |
| NPI Enumeration Date: | 02 Sep, 2006 |
| NPI Last Update On: | 08 Jul, 2007 |
Medical Licenses:
Doctors can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Paul Ivan Hathorn are as mentioned below.
| License Number | Specialization | State | Status | |
| 2342-87 | Dentistry | Mississippi | Primary | |
Other Medical Identifiers:
Other legacy medical identifiers associated with Paul Ivan Hathorn such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 00060323 | Medicaid | Mississippi | |
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | 1101 Highway 11 S,
Ellisville, Mississippi |
| Zip: | 39437-4443 |
| Phone Number: | 601-477-5792 |
| Fax Number: | 601-477-5782 |
Patients can reach Paul Ivan Hathorn at
1101 Highway 11 S, Ellisville, Mississippi or can
call to book an appointment on 601-477-5792.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on
08 December, 2025.