Individual
WILLIE M HARDIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
925 NE 136TH AVE, SUITE 101, VANCOUVER, WA 98684-0896
(360) 694-5559
(360) 891-0000
Mailing address
925 NE 136TH AVE, SUITE 101, VANCOUVER, WA 98684-0896
(360) 694-5559
(360) 891-0000
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DE00008741
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002369
—
WA
01
—
2007980
GROUP MEDICAID
WA
Enumeration date
10/27/2006
Last updated
09/14/2010
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