Provider Demographics
NPI:1174740146
Name:HONEYCUTT, LARRY DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DEAN
Last Name:HONEYCUTT
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 1:1240 MCARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-2445
Mailing Address - Country:US
Mailing Address - Phone:931-728-3501
Mailing Address - Fax:931-728-3554
Practice Address - Street 1:1240 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2445
Practice Address - Country:US
Practice Address - Phone:931-728-3501
Practice Address - Fax:931-728-3554
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3313122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440017Medicaid
4042896OtherBLUE CROSS BLUE SHEILD TN