MEDICARE: W. STAN HARDESTY, DDS, PA

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	1223G0001X	General Practice Dentistry	6229	NC

General Provider Information

NPI Number	:	1568674653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	W. STAN HARDESTY, DDS, PA

Provider Business Mailing Address
First Line	:	3200 BLUE RIDGE RD STE 122
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-8087
Country	:	US
Telephone Number	:	919-781-0018
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 BLUE RIDGE RD STE 122
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-8087
Country	:	US
Telephone Number	:	919-781-0018
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIS STANTON HARDESTY JR.
Credential	:	DDS
Telephone Number	:	919-781-0018

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	06/23/2025

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