Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | D6871 | OR |
NPI | 1053375089 |
---|---|
Provider Name | Dr. Tod M Hardin |
First Address | Boring, OR 97009-6003 |
Second Address | Gresham, OR 97030-7303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 08/07/2007 |