Healthcare Provider Details

I. General information

NPI: 1962981241
Provider Name (Legal Business Name): CAMAS ORTHODONTICS LLC TOD HARDIN SOLE MBR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 NW 38TH AVE STE 102
CAMAS WA
98607-5403
US

IV. Provider business mailing address

3605 GRANT DR
RENO NV
89509-5301
US

V. Phone/Fax

Practice location:
  • Phone: 360-953-8887
  • Fax:
Mailing address:
  • Phone: 775-409-4614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TOD MATHEW HARDIN
Title or Position: OWNER
Credential: DMD
Phone: 775-409-4614