Provider Demographics
NPI:1043231806
Name:HANDLEY, MARK A (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:HANDLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65556-0777
Mailing Address - Country:US
Mailing Address - Phone:573-708-7600
Mailing Address - Fax:573-723-1474
Practice Address - Street 1:401 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAVOIS MILLS
Practice Address - State:MO
Practice Address - Zip Code:65037-6253
Practice Address - Country:US
Practice Address - Phone:877-406-2662
Practice Address - Fax:573-207-2773
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140066451223G0001X
KS63111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1043231806Medicaid
KS1043231806Medicaid