Provider Demographics
NPI:1871682039
Name:HARDY, LUCAS A (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:A
Last Name:HARDY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 ARROYO DR SUITE 1
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604
Mailing Address - Country:US
Mailing Address - Phone:307-235-1600
Mailing Address - Fax:307-235-1601
Practice Address - Street 1:4611 ARROYO DR SUITE 1
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604
Practice Address - Country:US
Practice Address - Phone:307-235-1600
Practice Address - Fax:307-235-1601
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY11461223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY123102200Medicaid