Provider Demographics
NPI:1003038290
Name:HARDIN DENTAL CLINIC, PC
Entity Type:Organization
Organization Name:HARDIN DENTAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-665-3300
Mailing Address - Street 1:PO BOX 433
Mailing Address - Street 2:
Mailing Address - City:HARDIN
Mailing Address - State:MT
Mailing Address - Zip Code:59034-0433
Mailing Address - Country:US
Mailing Address - Phone:406-665-3300
Mailing Address - Fax:406-665-4290
Practice Address - Street 1:339 3RD ST W
Practice Address - Street 2:
Practice Address - City:HARDIN
Practice Address - State:MT
Practice Address - Zip Code:59034-1703
Practice Address - Country:US
Practice Address - Phone:406-665-3300
Practice Address - Fax:406-665-4290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT17171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT115661Medicaid
MT4OtherBLUE CROSS BLUE SHIELD
MT5510312OtherCHIP
MT857200OtherUNITED CONCORDIA