| NPI | 1174274021 |
|---|---|
| Doing Business As | LEGACY DENTAL SA |
| Entity Type | Organization |
| Authorized Contact | FAITH GASKINS Director Of Credentialing 972-869-3789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2022-01-12 |