Provider Demographics
NPI:1982889952
Name:HARDY, DANA LAUREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:LAUREN
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 1:4589 VIA MARISOL
Mailing Address - Street 2:#361
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-5138
Mailing Address - Country:US
Mailing Address - Phone:626-399-3131
Mailing Address - Fax:
Practice Address - Street 1:4589 VIA MARISOL
Practice Address - Street 2:#361
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-5138
Practice Address - Country:US
Practice Address - Phone:626-399-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55861122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist