Provider Demographics
NPI:1497976518
Name:HARDESTY, DANIEL LOUIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LOUIS
Last Name:HARDESTY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 BLIZZARD DR
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-6433
Mailing Address - Country:US
Mailing Address - Phone:304-485-4551
Mailing Address - Fax:304-428-0841
Practice Address - Street 1:1900 BLIZZARD DR
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-6433
Practice Address - Country:US
Practice Address - Phone:304-485-4551
Practice Address - Fax:304-428-0841
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV 34351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice