Provider Demographics
NPI:1578698502
Name:R. BEN HARDY, DMD, LLC
Entity Type:Organization
Organization Name:R. BEN HARDY, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-736-1135
Mailing Address - Street 1:2825 WASHINGTON RD
Mailing Address - Street 2:SUITE M2
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-2119
Mailing Address - Country:US
Mailing Address - Phone:706-736-1135
Mailing Address - Fax:706-736-1186
Practice Address - Street 1:2825 WASHINGTON RD
Practice Address - Street 2:SUITE M2
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2119
Practice Address - Country:US
Practice Address - Phone:706-736-1135
Practice Address - Fax:706-736-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0129131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZAG974Medicaid