Provider Demographics
NPI:1871118133
Name:TARDY ORTHODONTICS PC
Entity type:Organization
Organization Name:TARDY ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:TARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-453-8826
Mailing Address - Street 1:1220 HIGHWAY 287 N
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4804
Mailing Address - Country:US
Mailing Address - Phone:817-453-8826
Mailing Address - Fax:817-453-8830
Practice Address - Street 1:8805 NORTH TARRANT PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182
Practice Address - Country:US
Practice Address - Phone:817-898-1400
Practice Address - Fax:817-453-8830
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TARDY ORTHODONTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty