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NPI Code Detail

MEDICARE: MARTHA HARDAWAY DMD

MEDICARE: MARTHA HARDAWAY DMD
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
11223P0221XPediatric DentistryDN013173GA
21223P0221XPediatric Dentistry7984NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17984OTHERNCLICENSE
2DN013173OTHERLICENSE

General Provider Information

NPI Number : 1942365044
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA HARDAWAY DMD
Provider Business Mailing Address
First Line : 373 BOONE HEIGHTS DR
Second Line :
City : BOONE
State : NC
Zip : 28607-4934
Country : US
Telephone Number : 828-264-0110
Fax Number : 828-264-5453
Provider Business Practice Location Address
First Line : 373 BOONE HEIGHTS DR
Second Line :
City : BOONE
State : NC
Zip : 28607-4934
Country : US
Telephone Number : 828-264-0110
Fax Number : 828-264-5453
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2006
Last Update Date : 03/07/2023

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