Provider Demographics
NPI:1407058159
Name:BICKNELL, LARRY ARTHUR (DDS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:ARTHUR
Last Name:BICKNELL
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 1:2540 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7286
Mailing Address - Country:US
Mailing Address - Phone:928-344-5700
Mailing Address - Fax:928-344-3645
Practice Address - Street 1:2540 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7286
Practice Address - Country:US
Practice Address - Phone:928-344-5700
Practice Address - Fax:928-344-3645
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice