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NPI Code Detail

MEDICARE: DR. DESIREE HARDY DDS

MEDICARE: DR. DESIREE HARDY DDS
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
1122300000XDentist1001833-15WI
2390200000XStudent in an Organized Health Care Education/Training Program
3122300000XDentist019.035004IL

General Provider Information

NPI Number : 1457840829
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DESIREE HARDY DDS
Provider Business Mailing Address
First Line : 347 W CHESTNUT ST UNIT 1909
Second Line :
City : CHICAGO
State : IL
Zip : 60610-3030
Country : US
Telephone Number : 414-416-5465
Fax Number :
Provider Business Practice Location Address
First Line : 1 CHICAGO AVE
Second Line :
City : OAK PARK
State : IL
Zip : 60302-2432
Country : US
Telephone Number : 708-948-7744
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2018
Last Update Date : 10/18/2024

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Directions to “ DR. DESIREE HARDY DDS” Practice Location

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