LEGACY DENTAL LLC (NPI# 1083704019) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083704019 |
| Entity Type | Organization |
| Organization Name | LEGACY DENTAL LLC |
| Other Organization Name | UEBER & FRIEDERICH DENTISTRY |
| Practice Address |
7215 Engle Rd. Fort Wayne IN 46804 |
| Practice Telephone | 2604341133 |
| Mailing Telephone | 2604341133 |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2020-08-17 |
| Authorized Official Name | MR. NATHAN JAMES BOJRAB (CEO) |
| Authorized Official Telephone | 2604341133 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223G0001X |
Dentist Specialization: General Practice |
12008943 | IN | Dental Providers |
| N | 1223G0001X |
Dentist Specialization: General Practice |
12009422 | IN | Dental Providers |
| Y | 1223G0001X |
Dentist Specialization: General Practice |
12010440 | IN | Dental Providers |
| Other Name | Type Code |
|---|---|
| Ueber & Friederich Dentistry | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215332754 | Legacy Dental LLC | Clinic/Center | 4520 Lower Terrace Cir Ne, Albuquerque, NM 87111-2503 | 2014-10-27 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | Legacy Dental LLC | 305 W Fayette St Ste 1613, Baltimore, Maryland 21201 |
| Street Address |
7215 ENGLE RD. |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679186258 | James Patrick Thompson | Dentist | 5909 Wheelock Rd Ste 102, Fort Wayne, IN 46835-9258 | 2020-08-25 |
| 1295357481 | Sycamore Hills Dentistry | Dentist | 10082 Illinois Rd, Fort Wayne, IN 46804-5772 | 2020-05-11 |
| 1699324103 | Phillip M. Mckean Professional Corporation | Dentist | 6605 E State Blvd Ste 7, Fort Wayne, IN 46815-7036 | 2019-09-06 |
| 1598322083 | Charles Chase Ellinwood | Dentist | 5725 Maplecrest Rd Ste 1, Fort Wayne, IN 46835-4937 | 2019-05-21 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1821582172 | Jacob Yager | Dentist | 9830 Auburn Rd Ste 101, Fort Wayne, IN 46825-2464 | 2018-06-20 |
| 1740772656 | Colleen Rose Allen | Dentist | 10213 Dupont Circle Dr W, Fort Wayne, IN 46825-1656 | 2018-06-06 |
| 1407360910 | Grace Xinxing Clark | Dentist | 4716 Illinois Rd Ste 101, Fort Wayne, IN 46804-5123 | 2017-11-20 |
| 1578959375 | Ronald L Rumbaugh Dds PC | Dentist | 10506 Coldwater Rd, Fort Wayne, IN 46845-1235 | 2015-04-09 |
| 1619388063 | Familia Dental Spfw Pllc | Dentist | 100 E Pettit Ave, 1a, Fort Wayne, IN 46806-3003 | 2014-05-19 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.