Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 32583 | TX |
NPI | 1063077410 |
---|---|
Provider Name | Dr. Calvin Tardy |
First Address | Mansfield, TX 76063-4804 |
Second Address | Mansfield, TX 76063-4804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2019 |
Last Update Date | 01/05/2019 |