Provider Demographics
NPI:1750608691
Name:HARDY, DOUGLAS C (DMD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:C
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 1:1975 RESEARCH PARKWAY SUITE 305
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80020
Mailing Address - Country:US
Mailing Address - Phone:719-599-7760
Mailing Address - Fax:
Practice Address - Street 1:8749 WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-0907
Practice Address - Country:US
Practice Address - Phone:303-424-5463
Practice Address - Fax:303-424-4830
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101491223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics