Basic Information
| Provider Information | |||||||||
| NPI: | 1992010144 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARDY | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1015 S TAFT HILL RD | ||||||||
| Address2: | SUITE Q | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805214240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9709802145 | ||||||||
| FaxNumber: | 9709802142 | ||||||||
| Practice Location | |||||||||
| Address1: | 1015 S TAFT HILL RD | ||||||||
| Address2: | SUITE Q | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805214240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9709802145 | ||||||||
| FaxNumber: | 9709802142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2010 | ||||||||
| LastUpdateDate: | 02/16/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | DEN.00202076 | CO | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
ID Information
| ID | Type | State | Issuer | Description | DEN.00202076 | 01 | CO | DENTAL LICENSE | OTHER |