DR. JACK BENJAMIN HARDY (NPI# 1093951352) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093951352 |
| Entity Type | Individual |
| Full Name | DR. JACK BENJAMIN HARDY |
| Credential | D.M.D. |
| Practice Address |
4611 Arroyo Dr Suite 1 Casper WY 82604-5116 |
| Practice Telephone | 3072351600 |
| Mailing Telephone | 3072351600 |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2015-12-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223G0001X |
Dentist Specialization: General Practice |
57754 | CA | Dental Providers |
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
WY1265 | WY | Dental Providers |
| Street Address |
4611 ARROYO DR SUITE 1 |
| City | CASPER |
| State | WY |
| Zip Code | 82604-5116 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518489335 | Sasha Marie Baker | Behavior Technician | 945 Pendell Blvd, Casper, WY 82604 | 2017-07-13 |
| 1083161566 | Lori Norby | Registered Nurse | 6641 Monarch Ct, Casper, WY 82604 | 2016-09-01 |
| 1245601020 | Living for A Change LLC | Social Worker | 2045 Laramie Ave, Casper, WY 82604 | 2015-10-19 |
| 1225406754 | Patricia Masters | Respite Care | 6678 Bailey Place, Casper, WY 82604 | 2015-09-15 |
| 1619364437 | Daniel Dalen | Specialist/Technologist | 2342 Odell, Casper, WY 82604 | 2015-04-20 |
| 1568883064 | Rocky Mountain Holdings, LLC | Ambulance | 7798 Fuller St, Casper, WY 82604 | 2013-12-31 |
| 1902191638 | Diana Pauline Quealy-berge | Counselor | 3920 Swingle, Casper, WY 82604 | 2011-06-10 |
| 1093938839 | Kelly L Heenan | Counselor | 3741 Arroyo Drive, Casper, WY 82604 | 2007-04-10 |
| 1649393943 | Leslie Keeler | Case Manager/Care Coordinator | 630 10 Mile Road, Casper, WY 82604 | 2007-04-09 |
| 1386778223 | Wyoming Health Fairs | Technician, Pathology | 115 South Elm St, Casper, WY 82604 | 2007-03-15 |
| Find all providers in zip 82604 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558439265 | Robert Allan Hageman | Dentist | 1224 E 2nd St, Casper, WY 82601 | 2006-12-01 |
| 1871682039 | Lucas A Hardy | Dentist | 4611 Arroyo Dr Suite 1, Casper, WY 82604 | 2006-10-12 |
| 1356630057 | Wyoming Oral & Maxillofacial Surgery P. C. | Dentist | 4611 Arroyo Dr Suite 1, Casper, WY 82604 | 2011-04-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639792450 | Dr Riley PC | Dentist | 1325 S Hwy 89 Apt 105, Jackson, WY 83001-8293 | 2020-05-27 |
| 1740776202 | Teton Oral and Maxillofacial Surgery | Dentist | 1160 Alpine Ln Ste 1d, Jackson, WY 83001 | 2018-07-09 |
| 1114291887 | Frontier Oral Surgery and Implant Center | Dentist | 7209 Commons Cir, Unit A, Cheyenne, WY 82009-2644 | 2012-02-28 |
| 1083852149 | Michael Stern | Dentist | 1160 Alpine Ln, Suite 1d, Jackson, WY 83001 | 2009-01-28 |
| 1750437380 | Roland Brant Gustafson | Dentist | 6238 Yellowstone Rd, Cheyenne, WY 82009-3432 | 2007-01-26 |
| 1164430971 | Teton Oral & Maxillofacial Surgery | Dentist | 1160 Alpine Lane, #1d, Jackson, WY 83002 | 2006-08-04 |
| 1821610957 | Star Valley Oral Surgery | Dentist | 487 N Main, Suite B, Thayne, WY 83127 | 2020-05-12 |
| 1760856710 | Oral & Maxillofacial Surgeons of Wyoming | Dentist | 2405 Cascade Dr, Rock Springs, WY 82901-5580 | 2015-11-13 |
| 1336582212 | Chad William Petersen | Dentist | 6238 Yellowstone Rd, Cheyenne, WY 82009-3432 | 2013-04-10 |
| 1649575465 | Bear River Dental | Dentist | 50 Park Rd, Evanston, WY 82930-2613 | 2011-01-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.