Provider Demographics
NPI:1780719930
Name:HARDIGREE, CLABERN THOMAS (DMD)
Entity type:Individual
Prefix:
First Name:CLABERN
Middle Name:THOMAS
Last Name:HARDIGREE
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 1:3308 BELLEFONTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502
Mailing Address - Country:US
Mailing Address - Phone:859-278-2654
Mailing Address - Fax:859-277-3552
Practice Address - Street 1:129 CHERRYBARK DRIVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-277-8012
Practice Address - Fax:859-277-3552
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY49581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice