Provider Demographics
NPI:1295835056
Name:HARDINA, JUDD G (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUDD
Middle Name:G
Last Name:HARDINA
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:LANDSTUHL DENTAL ACTIVITY CREDENTIALS OFFICE
Mailing Address - Street 2:CMR 402
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:US
Mailing Address - Phone:01149637-192-9130
Mailing Address - Fax:01149637-192-9117
Practice Address - Street 1:LANDSTUHL DENTAL ACTIVITY CREDENTIALS OFFICE
Practice Address - Street 2:CMR 402
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:US
Practice Address - Phone:01149637-192-9130
Practice Address - Fax:01149637-192-9117
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA590501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice