Provider Demographics
NPI:1376797233
Name:HARDY, CASEY LEIGH (RDH)
Entity Type:Individual
Prefix:MS
First Name:CASEY
Middle Name:LEIGH
Last Name:HARDY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:CASEY
Other - Middle Name:LEIGH
Other - Last Name:PERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:CMR 402
Mailing Address - Street 2:LANDSUHL DENTAL ACTIVITY CREDENTIALS OFFICE
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:US
Mailing Address - Phone:49637-192-9130
Mailing Address - Fax:49637-192-9191
Practice Address - Street 1:CMR 402
Practice Address - Street 2:LANDSUHL DENTAL ACTIVITY CREDENTIALS OFFICE
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:US
Practice Address - Phone:49637-192-9130
Practice Address - Fax:49637-192-9191
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3548124Q00000X
TX14463124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist