Provider Demographics
NPI:1508247552
Name:HARDY, JOHN C II (D,MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:HARDY
Suffix:II
Gender:M
Credentials:D,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2457 OAKMONT WAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6460
Mailing Address - Country:US
Mailing Address - Phone:541-484-2046
Mailing Address - Fax:541-683-5333
Practice Address - Street 1:2457 OAKMONT WAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6460
Practice Address - Country:US
Practice Address - Phone:541-484-2046
Practice Address - Fax:541-683-5333
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD102421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice