Provider Demographics
NPI:1902061062
Name:HARDEE, SHEILA LAVERN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:LAVERN
Last Name:HARDEE
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 1:13245 BOOKER T WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:VA
Mailing Address - Zip Code:24101-3980
Mailing Address - Country:US
Mailing Address - Phone:540-721-2448
Mailing Address - Fax:
Practice Address - Street 1:13245 BOOKER T WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:HARDY
Practice Address - State:VA
Practice Address - Zip Code:24101-3980
Practice Address - Country:US
Practice Address - Phone:540-721-2448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401-007397122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist