Provider Demographics
NPI:1588116305
Name:TARDY, SHELLEY R (DDS, MSD)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:R
Last Name:TARDY
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 PARK PLACE CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-5891
Mailing Address - Country:US
Mailing Address - Phone:817-453-8826
Mailing Address - Fax:817-453-8830
Practice Address - Street 1:1220 HIGHWAY 287 N
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4804
Practice Address - Country:US
Practice Address - Phone:817-453-8826
Practice Address - Fax:817-453-8830
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX164001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics