Provider Demographics
NPI:1689445751
Name:HARDY, MONIQUE YVETTE (RDH)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:YVETTE
Last Name:HARDY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:YVETTE
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:2806 BELT LOOP
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-5929
Mailing Address - Country:US
Mailing Address - Phone:931-538-8863
Mailing Address - Fax:
Practice Address - Street 1:3600 SHOEMAKER LANE
Practice Address - Street 2:SUITE 1051
Practice Address - City:FT CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544-5054
Practice Address - Country:US
Practice Address - Phone:254-287-3319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5328124Q00000X
TX24623124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist