Healthcare Provider Details

I. General information

NPI: 1164513818
Provider Name (Legal Business Name): JOHN L HARDESTY DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14527 N CHESHIRE ST
BURTON OH
44021
US

IV. Provider business mailing address

14527 N CHESHIRE ST PO BOX 401
BURTON OH
44021
US

V. Phone/Fax

Practice location:
  • Phone: 440-834-4020
  • Fax: 440-834-1971
Mailing address:
  • Phone: 440-834-4020
  • Fax: 440-834-1971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17792
License Number StateOH

VIII. Authorized Official

Name: DR. JOHN L HARDESTY
Title or Position: OFFICER
Credential: DDS
Phone: 440-834-4020