Healthcare Provider Details

I. General information

NPI: 1942929146
Provider Name (Legal Business Name): TOD M HARDIN, DMD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12409 E MIRABEAU PKWY STE 200
SPOKANE VALLEY WA
99216-5056
US

IV. Provider business mailing address

3605 GRANT DR
RENO NV
89509-5301
US

V. Phone/Fax

Practice location:
  • Phone: 509-239-8710
  • Fax:
Mailing address:
  • Phone: 775-409-4614
  • Fax: 775-409-4614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ALETA BEUTER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 775-409-4614