Provider Demographics
NPI:1629067194
Name:HARDISON, MARK F (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:F
Last Name:HARDISON
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 1:1272 DOW ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2468
Mailing Address - Country:US
Mailing Address - Phone:615-893-7736
Mailing Address - Fax:615-898-1771
Practice Address - Street 1:1272 DOW ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2468
Practice Address - Country:US
Practice Address - Phone:615-893-7736
Practice Address - Fax:615-898-1771
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS72481223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU84867Medicare UPIN