Individual
JESSICA AMANDA HARDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1588 N. COAL CREEK RD., PRICE, UT 84501-8450
(435) 820-6666
Mailing address
1588 N COAL CREEK RD, PRICE, UT 84501-7615
(435) 820-6666
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D010048
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D010048
ARIZONA STATE BOARD OF DENTAL EXAMINERS
AZ
Enumeration date
08/08/2018
Last updated
08/08/2018
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