Provider Demographics
NPI:1801968078
Name:HANDERHAN, LEO R JR
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:R
Last Name:HANDERHAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 LAUREL BUSH RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6185
Mailing Address - Country:US
Mailing Address - Phone:410-515-1122
Mailing Address - Fax:
Practice Address - Street 1:2105 LAUREL BUSH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6185
Practice Address - Country:US
Practice Address - Phone:410-515-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD84961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice