Provider Demographics
NPI:1548489826
Name:HIMEBAUGH, LARRY DAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DAYNE
Last Name:HIMEBAUGH
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 1:10269 ALLAMANDA BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-5215
Mailing Address - Country:US
Mailing Address - Phone:561-495-8585
Mailing Address - Fax:
Practice Address - Street 1:591 W CHICAGO ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-9189
Practice Address - Country:US
Practice Address - Phone:517-279-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010089941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice