Healthcare Provider Details

I. General information

NPI: 1215275730
Provider Name (Legal Business Name): HARDIN ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 NE HOOD AVE SUITE 305
GRESHAM OR
97030-7303
US

IV. Provider business mailing address

501 NE HOOD AVE SUITE 305
GRESHAM OR
97030-7303
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-2196
  • Fax:
Mailing address:
  • Phone: 503-666-2196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. TOD MATTHEW HARDIN
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 503-666-2196