Provider Demographics
NPI:1255914107
Name:HARDWICK-JOHNSON, SHERRY (RDH)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:
Last Name:HARDWICK-JOHNSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2477
Mailing Address - Country:US
Mailing Address - Phone:313-202-8655
Mailing Address - Fax:
Practice Address - Street 1:4909 E OUTER DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-3446
Practice Address - Country:US
Practice Address - Phone:313-366-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902011914124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist