Individual provider Active NPI

Timothy James Hardy, D.D.S.

  • Dentist
  • Boerne, TX
National Provider Identifier
1881819704
Registry record updated Aug 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
13624 Issued in TX
Practice address
1112 S Main St Ste a
Boerne, TX 78006-2812
Phone
(830) 755-6475
Fax
(210) 494-1127
NPI assigned
Apr 16, 2007
Last updated
Aug 3, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 13624 TX Primary

Addresses

Primary practice location

1112 S Main St Ste a
Boerne, TX 78006-2812

Mailing address

17020 San Pedro Ave
Suite 130
San Antonio, TX 78232-2263
Phone (210) 494-1717

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160301001142 TX Order and Referring Only - DentistPractitioner - Dentist 3274838172

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13624TXMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Boerne Family Dental PLLC General Practice PastSince Aug 1, 2020 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785715200000",
    "number": "1881819704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17020 SAN PEDRO AVE",
            "address_2": "SUITE 130",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782322263",
            "telephone_number": "210-494-1717",
            "fax_number": "210-494-1127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 S MAIN ST STE A",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780062812",
            "telephone_number": "830-755-6475",
            "fax_number": "210-494-1127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDY",
        "first_name": "TIMOTHY",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-16",
        "last_updated": "2026-08-03",
        "certification_date": "2026-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "13624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boerne, TX

Sources for this page

Verify at the official NPI Registry.