Provider Demographics
NPI:1770680829
Name:TARDY ORTHODONTICS PC
Entity Type:Organization
Organization Name:TARDY ORTHODONTICS PC
Other - Org Name:SMILE HOUZZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:TARDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:817-453-8826
Mailing Address - Street 1:1220 HWY 287 NORTH
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063
Mailing Address - Country:US
Mailing Address - Phone:817-453-8826
Mailing Address - Fax:817-453-8830
Practice Address - Street 1:1220 HWY 287 NORTH
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063
Practice Address - Country:US
Practice Address - Phone:817-453-8826
Practice Address - Fax:817-453-8830
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TARDY ORTHODONTICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0164001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty