Provider Demographics
NPI:1205057387
Name:HARDWICK, ROBERT WALTER JR (DDS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WALTER
Last Name:HARDWICK
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 978
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:WA
Mailing Address - Zip Code:99166
Mailing Address - Country:US
Mailing Address - Phone:509-775-3169
Mailing Address - Fax:509-775-2272
Practice Address - Street 1:194 NORTH PORTLAND ST.
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:WA
Practice Address - Zip Code:99166
Practice Address - Country:US
Practice Address - Phone:509-775-3169
Practice Address - Fax:509-775-2272
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA50701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5027230Medicaid