Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 2671 | TN |
NPI | 1083793533 |
---|---|
Provider Name | Dr. Joel Allen Hardin |
First Address | Decatur, AL 35603 |
Second Address | Decatur, AL 35603-4293 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 08/07/2007 |