Provider Demographics
NPI:1821857137
Name:HARDING, TATE JOHN
Entity Type:Individual
Prefix:
First Name:TATE
Middle Name:JOHN
Last Name:HARDING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 KELLY CT
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-8033
Mailing Address - Country:US
Mailing Address - Phone:208-604-4598
Mailing Address - Fax:
Practice Address - Street 1:6900 FOREST AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1729
Practice Address - Country:US
Practice Address - Phone:804-893-8715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04420005131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry