MEDICARE: DR. LARRY W LEDDY DDS MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	9070	MI

General Provider Information

NPI Number	:	1144254160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY W LEDDY DDS MS

Provider Business Mailing Address
First Line	:	5355 COLONY DRIVE NORTH
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48638-7190
Country	:	US
Telephone Number	:	989-792-7056
Fax Number	:	989-792-5031

Provider Business Practice Location Address
First Line	:	5355 COLONY DRIVE NORTH
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48638-7190
Country	:	US
Telephone Number	:	989-792-7056
Fax Number	:	989-792-5031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/08/2007

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