Provider Demographics
NPI:1790475846
Name:HARDY, CHASE DAVID (DMD)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:DAVID
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 1:1962 W NICHOLAS FARM LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-1257
Mailing Address - Country:US
Mailing Address - Phone:801-835-1863
Mailing Address - Fax:
Practice Address - Street 1:59 W PAGES LN STE 110
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5988
Practice Address - Country:US
Practice Address - Phone:801-835-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13453002-9921122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program