Provider Demographics
NPI:1538365499
Name:HARDIN, COURTNEY NICOLLE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:NICOLLE
Last Name:HARDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3977 SEVENTH STREET ROAD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216
Mailing Address - Country:US
Mailing Address - Phone:502-449-1961
Mailing Address - Fax:502-449-9866
Practice Address - Street 1:3977 SEVENTH STREET ROAD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216
Practice Address - Country:US
Practice Address - Phone:502-449-1961
Practice Address - Fax:502-449-9866
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY84901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice