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General NPI Number Information
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NPI Number | 1871118133
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Entity Type | Organization
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Legal Business Name | TARDY ORTHODONTICS PC
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Dates
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Enumeration Date | 06/12/2020
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Last Update Date | 06/12/2020
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Provider Practice Location Address
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Address Line | 8805 NORTH TARRANT PARKWAY SUITE 200
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76182
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Country | US
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Telephone | 817-898-1400
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Fax | 817-453-8830
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Provider Business Mailing Address
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Address Line | 1220 HIGHWAY 287 N
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City | MANSFIELD
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State | TX
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Zip | 76063-4804
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Country | US
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Telephone | 817-453-8826
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Fax | 817-453-8830
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Authorized Official
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Title or Position | DDS
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Name | SHELLEY R. TARDY
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Credential |
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Telephone | 817-453-8826
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #3
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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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