MEDICARE: HARDY PEDIATRIC DENTISTRY AND ORTHODONTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DEN.00202275	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DEN.00202275	OTHER	CO	DENTAL LICENSE

General Provider Information

NPI Number	:	1174978290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARDY PEDIATRIC DENTISTRY AND ORTHODONTICS

Provider Business Mailing Address
First Line	:	3200 VILLAGE VISTA DR
Second Line	:	SUITE B
City	:	ERIE
State	:	CO
Zip	:	80516-2521
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 VILLAGE VISTA DR
Second Line	:	SUITE B
City	:	ERIE
State	:	CO
Zip	:	80516-2521
Country	:	US
Telephone Number	:	720-308-1424
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NAMRATA GUPTE HARDY
Credential	:	DMD
Telephone Number	:	720-308-1424

Provider Enumeration Date	:	04/26/2016
Last Update Date	:	04/26/2016

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Directions to “HARDY PEDIATRIC DENTISTRY AND ORTHODONTICS ” Practice Location

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