Provider Demographics
NPI:1457840829
Name:HARDY, DESIREE (DDS)
Entity type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:
Last Name:HARDY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 W CHESTNUT ST UNIT 1909
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3030
Mailing Address - Country:US
Mailing Address - Phone:414-416-5465
Mailing Address - Fax:
Practice Address - Street 1:1 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2432
Practice Address - Country:US
Practice Address - Phone:708-948-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001833-15122300000X
390200000X
IL019.035004122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program