Healthcare Provider Details

I. General information

NPI: 1578098349
Provider Name (Legal Business Name): CHRISTOPHER MARINO HARDY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST BOX 19
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

9412 FOREST STATION CV
COLLIERVILLE TN
38017-3313
US

V. Phone/Fax

Practice location:
  • Phone: 424-338-2710
  • Fax:
Mailing address:
  • Phone: 901-233-5366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: