1376797233 NPI number — MS. CASEY LEIGH HARDY RDH

Table of content: MS. CASEY LEIGH HARDY RDH (NPI 1376797233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376797233 NPI number — MS. CASEY LEIGH HARDY RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARDY
Provider First Name:
CASEY
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RDH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PERSON
Provider Other First Name:
CASEY
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376797233
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CMR 402
Provider Second Line Business Mailing Address:
LANDSUHL DENTAL ACTIVITY CREDENTIALS OFFICE
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
496371929130
Provider Business Mailing Address Fax Number:
496371929191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CMR 402
Provider Second Line Business Practice Location Address:
LANDSUHL DENTAL ACTIVITY CREDENTIALS OFFICE
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
496371929130
Provider Business Practice Location Address Fax Number:
496371929191
Provider Enumeration Date:
11/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  3548 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 124Q00000X , with the licence number: 14463 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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