Provider Demographics
NPI:1154772648
Name:HARDESTY, GRANT (DMD)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:
Last Name:HARDESTY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-5767
Mailing Address - Country:US
Mailing Address - Phone:336-475-8181
Mailing Address - Fax:
Practice Address - Street 1:1602 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-5767
Practice Address - Country:US
Practice Address - Phone:336-475-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-26
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice