Provider Demographics
NPI:1518040187
Name:HARDY, BENJAMIN GERALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:GERALD
Last Name:HARDY
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 1:11516 MIRACLE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5311
Mailing Address - Country:US
Mailing Address - Phone:402-867-6247
Mailing Address - Fax:402-867-6248
Practice Address - Street 1:11516 MIRACLE HILLS DR STE 101
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4473
Practice Address - Country:US
Practice Address - Phone:402-867-6247
Practice Address - Fax:402-867-6248
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE64971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice