Healthcare Provider Details

I. General information

NPI: 1720249337
Provider Name (Legal Business Name): KEN B, HANDY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 05/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 N ZARAGOZA RD
EL PASO TX
79936-7905
US

IV. Provider business mailing address

8151 E INDIAN BEND RD STE 111
SCOTTSDALE AZ
85250-4826
US

V. Phone/Fax

Practice location:
  • Phone: 480-607-9999
  • Fax:
Mailing address:
  • Phone: 480-607-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7397758-9923
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD-4155
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: