Healthcare Provider Details

I. General information

NPI: 1629067194
Provider Name (Legal Business Name): MARK F. HARDISON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1272 DOW ST
MURFREESBORO TN
37130-2468
US

IV. Provider business mailing address

1272 DOW ST
MURFREESBORO TN
37130-2468
US

V. Phone/Fax

Practice location:
  • Phone: 615-893-7736
  • Fax: 615-898-1771
Mailing address:
  • Phone: 615-893-7736
  • Fax: 615-898-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDS7248
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: