Provider Demographics
NPI:1548389422
Name:HARDTKE, TIMOTHY GERALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GERALD
Last Name:HARDTKE
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 1:2222 MERIDIAN AVE E
Mailing Address - Street 2:SUITE C
Mailing Address - City:EDGEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98371-1032
Mailing Address - Country:US
Mailing Address - Phone:253-952-6112
Mailing Address - Fax:253-927-8770
Practice Address - Street 1:2222 MERIDIAN AVE E
Practice Address - Street 2:SUITE C
Practice Address - City:EDGEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98371-1032
Practice Address - Country:US
Practice Address - Phone:253-952-6112
Practice Address - Fax:253-927-8770
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA53551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice