Provider Demographics
NPI:1679164339
Name:STEPHANIE J HARDWICK DDS INC
Entity Type:Organization
Organization Name:STEPHANIE J HARDWICK DDS INC
Other - Org Name:MT. TAM PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:HARDWICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-329-6780
Mailing Address - Street 1:267 CORTE MADERA AVE
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1306
Mailing Address - Country:US
Mailing Address - Phone:775-303-2282
Mailing Address - Fax:
Practice Address - Street 1:770 TAMALPAIS DR STE 317
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1737
Practice Address - Country:US
Practice Address - Phone:775-303-2282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1881969517OtherNPI TY1