Provider Demographics
NPI:1912339151
Name:HARDY WEBSTER DENTAL, PLLC
Entity type:Organization
Organization Name:HARDY WEBSTER DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:KING
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-446-7353
Mailing Address - Street 1:90 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-3922
Mailing Address - Country:US
Mailing Address - Phone:281-446-7353
Mailing Address - Fax:281-446-0789
Practice Address - Street 1:90 WILSON RD
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3922
Practice Address - Country:US
Practice Address - Phone:281-446-7353
Practice Address - Fax:281-446-0789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25506261QD0000X
TX14308261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental