NPIMap

Organization Active NPI

Republic Dental Clinic

  • Dentist
  • Republic, WA
National Provider Identifier
1164749396
Registry record updated Apr 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5070 Issued in WA
Legal business name
REPUBLIC DENTAL CLINIC
Practice address
194 N. Portland St.
Republic, WA 99166-0978
Phone
(509) 775-3169
Fax
(509) 775-2272
NPI assigned
Apr 28, 2010
Last updated
Apr 28, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2010

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

Authorized official

Name
Dr. Robert W. Hardwick Jr., D.D.S.NPI 1205057387
Title
Owner/Dentist
Phone
(509) 775-3169

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 5070 WA Primary

Addresses

Primary practice location

194 N. Portland St.
Republic, WA 99166-0978

Mailing address

PO Box 978
Republic, WA 99166-0978
Phone (509) 775-3169

Other identifiers 1

IdentifierTypeStateIssuer
5027230MedicaidWA

Other names 1

  • Rob Hardwick, D.D.S. Other name

National Provider Directory

National Provider Directory

Locations

194 N Portland St
Republic, WA 99166
Phone (509) 775-3169

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1272412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272412800000",
    "number": "1164749396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 978",
            "city": "REPUBLIC",
            "state": "WA",
            "postal_code": "991660978",
            "telephone_number": "509-775-3169",
            "fax_number": "509-775-2272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "194 N. PORTLAND ST.",
            "city": "REPUBLIC",
            "state": "WA",
            "postal_code": "991660978",
            "telephone_number": "509-775-3169",
            "fax_number": "509-775-2272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REPUBLIC DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-28",
        "last_updated": "2010-04-28",
        "status": "A",
        "authorized_official_last_name": "HARDWICK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "509-775-3169",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "5070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5027230",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rob Hardwick, D.D.S.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Republic, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2010; 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.