MEDICARE: DR. TIMOTHY C HARDY 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
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DEN.00202076	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DEN.00202076	OTHER	CO	DENTAL LICENSE

General Provider Information

NPI Number	:	1992010144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY C HARDY DMD

Provider Business Mailing Address
First Line	:	1015 S TAFT HILL RD
Second Line	:	SUITE Q
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-4240
Country	:	US
Telephone Number	:	970-980-2145
Fax Number	:	970-980-2142

Provider Business Practice Location Address
First Line	:	1015 S TAFT HILL RD
Second Line	:	SUITE Q
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-4240
Country	:	US
Telephone Number	:	970-980-2145
Fax Number	:	970-980-2142

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

Provider Enumeration Date	:	08/12/2010
Last Update Date	:	02/16/2016

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