MEDICARE: HARDY DENTAL SPECIALISTS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DEN00202076	CO

General Provider Information

NPI Number	:	1619305257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARDY DENTAL SPECIALISTS, PC

Provider Business Mailing Address
First Line	:	1015 S TAFT HILL RD
Second Line	:	UNIT Q
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-4240
Country	:	US
Telephone Number	:	970-980-2145
Fax Number	:	970-980-2142

Provider Business Practice Location Address
First Line	:	1015 S TAFT HILL RD
Second Line	:	UNIT Q
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-4240
Country	:	US
Telephone Number	:	970-980-2145
Fax Number	:	970-980-2142

Authorized Official
Title or Position	:	OWNER AND ORTHODONTIST
Name	:	DR. TIMOTHY CHARLES HARDY
Credential	:	DMD
Telephone Number	:	720-308-1424

Provider Enumeration Date	:	10/17/2013
Last Update Date	:	10/17/2013

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