Provider Demographics
NPI:1144254160
Name:LEDDY, LARRY W (DDS MS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:W
Last Name:LEDDY
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:W
Other - Last Name:LEDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS MS PC
Mailing Address - Street 1:5355 COLONY DRIVE NORTH
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-7190
Mailing Address - Country:US
Mailing Address - Phone:989-792-7056
Mailing Address - Fax:989-792-5031
Practice Address - Street 1:5355 COLONY DRIVE NORTH
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-7190
Practice Address - Country:US
Practice Address - Phone:989-792-7056
Practice Address - Fax:989-792-5031
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI90701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics