Provider Demographics
NPI:1720249337
Name:HANDY, KEN B, (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:B,
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 1:8151 E INDIAN BEND RD
Mailing Address - Street 2:STE 111
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-4826
Mailing Address - Country:US
Mailing Address - Phone:480-607-9999
Mailing Address - Fax:
Practice Address - Street 1:1502 N ZARAGOZA RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7905
Practice Address - Country:US
Practice Address - Phone:480-607-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7397758-99231223G0001X
IDD-41551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice