Grant Michael Hardisty, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

12012807A Issued in IN

Practice address

924 Williams Park Dr
Bedford, IN 47421-6713

Phone

(812) 279-2022

Fax

(812) 277-9915

NPI assigned

Aug 20, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503187200000",
    "number": "1104342286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1377 ESTUARY DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462175267",
            "telephone_number": "317-937-2661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "924 WILLIAMS PARK DR",
            "city": "BEDFORD",
            "state": "IN",
            "postal_code": "474216713",
            "telephone_number": "812-279-2022",
            "fax_number": "812-277-9915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDISTY",
        "first_name": "GRANT",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-20",
        "last_updated": "2017-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12012807A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Lee Hall, D.D.S.
• Mark M Hall, DMD
• Stephen Richard Hammel, D.C.
• Diane Lee Michelle Hancock, CPHT
• Danielle L Harden, NP
• Wanda L. Harper, MS ED., LCAC CADACII
• Diana Hastings, LMHC
• Courtney Hawk, RBT
• Megan Hawk
• Tylar Haynes, RBT

• Dentist in Bedford, IN
• Providers in Bedford, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.