MEDICARE: DR. DANA LAUREN 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
1	122300000X	Dentist	55861	CA

General Provider Information

NPI Number	:	1982889952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANA LAUREN HARDY DDS

Provider Business Mailing Address
First Line	:	4589 VIA MARISOL
Second Line	:	#361
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-5138
Country	:	US
Telephone Number	:	626-399-3131
Fax Number	:

Provider Business Practice Location Address
First Line	:	4589 VIA MARISOL
Second Line	:	#361
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-5138
Country	:	US
Telephone Number	:	626-399-3131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2008
Last Update Date	:	04/08/2008

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