Provider Demographics
NPI:1871559666
Name:HARDY, ELLIOT (DDS)
Entity type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:
Last Name:HARDY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49204-0548
Mailing Address - Country:US
Mailing Address - Phone:517-784-3950
Mailing Address - Fax:517-783-2728
Practice Address - Street 1:817 W HIGH ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-2986
Practice Address - Country:US
Practice Address - Phone:517-784-9385
Practice Address - Fax:517-787-0852
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010150841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice