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General NPI Number Information
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NPI Number | 1174978290
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Entity Type | Organization
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Legal Business Name | HARDY PEDIATRIC DENTISTRY AND ORTHODONTICS
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 04/26/2016
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Provider Practice Location Address
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Address Line | 3200 VILLAGE VISTA DR SUITE B
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City | ERIE
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State | CO
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Zip | 80516-2521
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Country | US
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Telephone | 720-308-1424
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 VILLAGE VISTA DR SUITE B
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City | ERIE
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State | CO
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Zip | 80516-2521
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NAMRATA GUPTE HARDY
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Credential | DMD
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Telephone | 720-308-1424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DEN.00202275
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License Number State | CO
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