Provider Demographics
NPI:1124206644
Name:HARDIN, PHILIP A (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:A
Last Name:HARDIN
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 1:216 CUMBERLAND XING
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-9000
Mailing Address - Country:US
Mailing Address - Phone:606-348-3384
Mailing Address - Fax:
Practice Address - Street 1:216 CUMBERLAND XING
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-9000
Practice Address - Country:US
Practice Address - Phone:606-348-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY64971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60064979Medicaid