Active NPI
Dennis Ralph Hardin, GENERAL DENTIST
- General Practice Dentistry
- El Segundo, CA
National Provider Identifier
1558506113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 20757
- Practice address
- 222 N Sepulveda Blvd
El Segundo, CA 90245-5648 - Phone
- (800) 373-5400
- NPI assigned
- Dec 11, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 20757 | CA | Primary |
Addresses
Primary practice location
222 N Sepulveda Blvd
El Segundo, CA 90245-5648
Mailing address
222 N Sepulveda Blvd
El Segundo, CA 90245-5648
Phone (800) 373-5400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20757 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20757 | CA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270598400000",
"number": "1558506113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "222 N SEPULVEDA BLVD",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "902455648",
"telephone_number": "800-373-5400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "222 N SEPULVEDA BLVD",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "902455648",
"telephone_number": "800-373-5400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARDIN",
"first_name": "DENNIS",
"middle_name": "RALPH",
"credential": "GENERAL DENTIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-12-11",
"last_updated": "2010-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "20757",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "20757",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in El Segundo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 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.