Provider Demographics
NPI:1578640165
Name:HANDY, LARRY BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:BRUCE
Last Name:HANDY
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 1:7 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4020
Mailing Address - Country:US
Mailing Address - Phone:515-576-3691
Mailing Address - Fax:
Practice Address - Street 1:7 N 12TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4020
Practice Address - Country:US
Practice Address - Phone:515-576-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA065631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0177014Medicaid