| NPI | 1093119331 |
|---|---|
| Doing Business As | LEGACY PARK DENTAL |
| Entity Type | Organization |
| Authorized Contact | JACKI DANG Practice Manager 817-703-3791 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2014-10-15 |
| Last Update Date | 2014-10-15 |