Healthcare Provider Details

I. General information

NPI: 1750608691
Provider Name (Legal Business Name): DOUGLAS C. HARDY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8749 WADSWORTH BLVD
ARVADA CO
80003-0907
US

IV. Provider business mailing address

1975 RESEARCH PARKWAY SUITE 305
COLORADO SPRINGS CO
80020
US

V. Phone/Fax

Practice location:
  • Phone: 303-424-5463
  • Fax: 303-424-4830
Mailing address:
  • Phone: 719-599-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number10149
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: