Basic Information
| Provider Information | |||||||||
| NPI: | 1619305257 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HARDY DENTAL SPECIALISTS, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TAFT HILL ORTHODONTICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1015 S TAFT HILL RD | ||||||||
| Address2: | UNIT Q | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805214240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9709802145 | ||||||||
| FaxNumber: | 9709802142 | ||||||||
| Practice Location | |||||||||
| Address1: | 1015 S TAFT HILL RD | ||||||||
| Address2: | UNIT Q | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805214240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9709802145 | ||||||||
| FaxNumber: | 9709802142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2013 | ||||||||
| LastUpdateDate: | 10/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | HARDY | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | CHARLES | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER AND ORTHODONTIST | ||||||||
| AuthorizedOfficialTelephone: | 7203081424 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DMD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | DEN00202076 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.