Provider Demographics
NPI:1174978290
Name:HARDY PEDIATRIC DENTISTRY AND ORTHODONTICS
Entity type:Organization
Organization Name:HARDY PEDIATRIC DENTISTRY AND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAMRATA
Authorized Official - Middle Name:GUPTE
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:720-308-1424
Mailing Address - Street 1:3200 VILLAGE VISTA DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-2521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 VILLAGE VISTA DR
Practice Address - Street 2:SUITE B
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-2521
Practice Address - Country:US
Practice Address - Phone:720-308-1424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002022751223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODEN.00202275OtherDENTAL LICENSE