Provider Demographics
NPI:1407086978
Name:HARDY, STEFANIE KANGAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:KANGAS
Last Name:HARDY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 38TH ST SW
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4499
Mailing Address - Country:US
Mailing Address - Phone:701-282-4905
Mailing Address - Fax:701-282-9561
Practice Address - Street 1:1701 38TH ST SW
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4499
Practice Address - Country:US
Practice Address - Phone:701-282-4905
Practice Address - Fax:701-282-9561
Is Sole Proprietor?:No
Enumeration Date:2009-07-19
Last Update Date:2009-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND20541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice