Provider Demographics
NPI:1477763340
Name:HARDIN, TERRY DIANE (DDS)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:DIANE
Last Name:HARDIN
Suffix:
Gender:F
Credentials:DDS
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 1208
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-1208
Mailing Address - Country:US
Mailing Address - Phone:916-276-0519
Mailing Address - Fax:
Practice Address - Street 1:1004 RILEY ST
Practice Address - Street 2:STE. 5
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3260
Practice Address - Country:US
Practice Address - Phone:916-983-8870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0331441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice