Provider Demographics
NPI:1063668523
Name:HARDEE, PHILIP CAREY (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:CAREY
Last Name:HARDEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-1222
Mailing Address - Country:US
Mailing Address - Phone:334-222-1153
Mailing Address - Fax:334-427-7233
Practice Address - Street 1:1104 SANFORD RD
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-4150
Practice Address - Country:US
Practice Address - Phone:334-222-1153
Practice Address - Fax:334-427-7233
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics