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DR. JEREMY ALAN HARDY D.M.D.
General Practice >> Dentist >> Dental ProvidersRegistrant NPI Number: 1124266887
Individual Registrant:DR. JEREMY ALAN HARDY D.M.D.
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
18471 WILTERS ST ROBERTSDALE, AL 36567-6627 US
Tel: 251-947-3636 Fax: 251-947-3637
Tel: 251-947-3636 Fax: 251-947-3637
Contact information for business:
18471 WILTERS ST ROBERTSDALE, AL 36567-6627 US
Tel: 251-947-3636 Fax: 251-947-3637
Tel: 251-947-3636 Fax: 251-947-3637
Registration Information:
NPI: 1124266887
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 1223G0001X | Dental Providers Dentist General Practice | MS | 3371-06 |
| Y | 1223G0001X | Dental Providers Dentist | AL | 5790 C1 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 06377319 | MS | 05 |
