| NPI | 1720398910 |
|---|---|
| Doing Business As | LEGACY ORTHODONTICS |
| Entity Type | Organization |
| Authorized Contact | KAREN SUE MCCANN Practice Administrator 618-281-3399 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: MO 31267) |
| Enumeration Date | 2010-10-21 |
| Last Update Date | 2010-10-21 |