Provider Demographics
NPI:1902902646
Name:HARDY, ALBERT S III (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:S
Last Name:HARDY
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 COLLEGE PKWY
Mailing Address - Street 2:SUITE 307
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-3052
Mailing Address - Country:US
Mailing Address - Phone:802-655-5090
Mailing Address - Fax:802-655-9366
Practice Address - Street 1:792 COLLEGE PKWY
Practice Address - Street 2:SUITE 307
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3052
Practice Address - Country:US
Practice Address - Phone:802-655-5090
Practice Address - Fax:802-655-9366
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00011231223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1003069Medicaid
VTU01690Medicare UPIN
VT1003069Medicaid