MEDICARE: TARDY ORTHODONTICS PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
3	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1871118133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARDY ORTHODONTICS PC

Provider Business Mailing Address
First Line	:	1220 HIGHWAY 287 N
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-4804
Country	:	US
Telephone Number	:	817-453-8826
Fax Number	:	817-453-8830

Provider Business Practice Location Address
First Line	:	8805 NORTH TARRANT PARKWAY
Second Line	:	SUITE 200
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182
Country	:	US
Telephone Number	:	817-898-1400
Fax Number	:	817-453-8830

Authorized Official
Title or Position	:	DDS
Name	:	SHELLEY R. TARDY
Credential	:
Telephone Number	:	817-453-8826

Provider Enumeration Date	:	06/12/2020
Last Update Date	:	06/12/2020

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Directions to “TARDY ORTHODONTICS PC ” Practice Location

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