Provider Demographics
NPI:1760660294
Name:WILLIAM S. HARDEE JR. D.M.D., INC. FRIENDLY DENTAL CENTER
Entity Type:Organization
Organization Name:WILLIAM S. HARDEE JR. D.M.D., INC. FRIENDLY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARDEE
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:951-676-8920
Mailing Address - Street 1:28314 OLD TOWN FRONT ST
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-1814
Mailing Address - Country:US
Mailing Address - Phone:951-676-8920
Mailing Address - Fax:951-676-8976
Practice Address - Street 1:28314 OLD TOWN FRONT ST
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-1814
Practice Address - Country:US
Practice Address - Phone:951-676-8920
Practice Address - Fax:951-676-8976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA325611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1508957002Medicaid