Basic Information
| Provider Information | |||||||||
| NPI: | 1871559666 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARDY | ||||||||
| FirstName: | ELLIOT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 548 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492040548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177843950 | ||||||||
| FaxNumber: | 5177832728 | ||||||||
| Practice Location | |||||||||
| Address1: | 817 W HIGH ST | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492032986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177849385 | ||||||||
| FaxNumber: | 5177870852 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 03/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 2901015084 | MI | Y | Dental Providers | Dentist | General Practice |
No ID Information.