| NPI | 1740099241 |
|---|---|
| Doing Business As | LEGACY DENTAL |
| Entity Type | Organization |
| Authorized Contact | JOON JAE PARK President/Owner 262-720-4669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2024-12-31 |
| Last Update Date | 2024-12-31 |