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General NPI Number Information
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NPI Number | 1710563176
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Entity Type | Organization
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Legal Business Name | MARTHA HARDAWAY DMD MS PA
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Dates
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Enumeration Date | 03/24/2021
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Last Update Date | 03/24/2021
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Provider Practice Location Address
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Address Line | 247 MOUNT JEFFERSON STATE PARK RD STE 7
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City | WEST JEFFERSON
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State | NC
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Zip | 28694-8042
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Country | US
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Telephone | 919-604-1546
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Fax |
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Provider Business Mailing Address
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Address Line | 176 WIND WALKER CT
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City | BOONE
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State | NC
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Zip | 28607-5349
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Country | US
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Telephone | 919-604-1546
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARTHA HARDAWAY
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Credential | DMD MS
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Telephone | 919-604-1546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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