Provider Demographics
NPI:1033388145
Name:WILLIAM S. HARDEE JR. D.M.D., INC. FRIENDLY DENTAL CENTER
Entity Type:Organization
Organization Name:WILLIAM S. HARDEE JR. D.M.D., INC. FRIENDLY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARDEE
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:951-676-8920
Mailing Address - Street 1:39252 WINCHESTER RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3509
Mailing Address - Country:US
Mailing Address - Phone:951-894-7769
Mailing Address - Fax:951-894-7697
Practice Address - Street 1:39252 WINCHESTER RD
Practice Address - Street 2:SUITE 117
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-3509
Practice Address - Country:US
Practice Address - Phone:951-894-7769
Practice Address - Fax:951-894-7697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA325611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1508957002Medicaid