Provider Demographics
NPI:1306221528
Name:HARDY, JAMESON L (DMD)
Entity Type:Individual
Prefix:
First Name:JAMESON
Middle Name:L
Last Name:HARDY
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 920
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0920
Mailing Address - Country:US
Mailing Address - Phone:207-942-1442
Mailing Address - Fax:207-942-1832
Practice Address - Street 1:766 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3616
Practice Address - Country:US
Practice Address - Phone:207-942-1442
Practice Address - Fax:207-942-1832
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME43261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics