Provider Demographics
NPI:1336259878
Name:HARDINGER, JON LINCOLN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:LINCOLN
Last Name:HARDINGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 6TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-4815
Mailing Address - Country:US
Mailing Address - Phone:641-423-6172
Mailing Address - Fax:641-423-6248
Practice Address - Street 1:1339 6TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-4815
Practice Address - Country:US
Practice Address - Phone:641-423-6172
Practice Address - Fax:641-423-6248
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA64361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0164301Medicaid