Provider Demographics
NPI:1770788572
Name:HARDING, TIA (DDS)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:HARDING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:
Other - Last Name:CALKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5255 STILESBORO RD NW STE 150
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7738
Mailing Address - Country:US
Mailing Address - Phone:770-794-3332
Mailing Address - Fax:
Practice Address - Street 1:5255 STILESBORO RD NW STE 150
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7738
Practice Address - Country:US
Practice Address - Phone:770-794-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0135811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice