Provider Demographics
NPI:1053375089
Name:HARDIN, TOD M (DMD, PC)
Entity type:Individual
Prefix:DR
First Name:TOD
Middle Name:M
Last Name:HARDIN
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26252 SE KELSO RD
Mailing Address - Street 2:
Mailing Address - City:BORING
Mailing Address - State:OR
Mailing Address - Zip Code:97009-6003
Mailing Address - Country:US
Mailing Address - Phone:503-663-9571
Mailing Address - Fax:
Practice Address - Street 1:501 NE HOOD AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7303
Practice Address - Country:US
Practice Address - Phone:503-666-2196
Practice Address - Fax:503-492-8798
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD68711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics