LEGACY DENTAL LLC (NPI# 1215332754) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215332754 |
| Entity Type | Organization |
| Organization Name | LEGACY DENTAL LLC |
| Practice Address |
4520 Lower Terrace Cir Ne Albuquerque NM 87111-2503 |
| Practice Telephone | 5052994431 |
| Practice Fax Number | 5052910265 |
| Mailing Telephone | 5052994431 |
| Mailing Fax Number | 5052910265 |
| Enumeration Date | 2014-10-27 |
| Last Update Date | 2014-10-27 |
| Authorized Official Name | DR. STEWART J ANDERSON (OWNER/DENTIST) |
| Authorized Official Telephone | 5052994431 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
DD3103 | NM | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083704019 | Legacy Dental LLC | Dentist | 7215 Engle Rd., Fort Wayne, IN 46804 | 2006-10-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | Legacy Dental LLC | 305 W Fayette St Ste 1613, Baltimore, Maryland 21201 |
| Street Address |
4520 LOWER TERRACE CIR NE |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87111-2503 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568685816 | John W Rose | Dentist | 4520 Lower Terrace Cir Ne, Albuquerque, NM 87111-2563 | 2007-04-11 |
| 1396919106 | Stewart Joseph Anderson | Dentist | 4520 Lower Terrace Cir Ne, Albuquerque, NM 87111-2503 | 2008-04-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417438110 | Dehlen LLC | Counselor | 11000 Spain Rd Ne, Building E, Albuquerque, NM 87111 | 2018-08-22 |
| 1003313008 | Jessika Junick | Nurse Practitioner | 3825 Eubank Blvd Ne Ste A, Albuquerque, NM 87111 | 2018-04-07 |
| 1881113454 | Hayley Aragon-bell | Day Training/Habilitation Specialist | 3732 Mount Rainier Dr. Ne, Albuquerque, NM 87111 | 2017-09-14 |
| 1750803326 | Sarah Mckenzie Ochoa | Day Training/Habilitation Specialist | 3916 Garcia St Ne, Albuquerque, NM 87111 | 2017-07-14 |
| 1285179549 | Family Dental Health Care | Dentist | 4550 Eubank Blvd, Suite 203, Albuquerque, NM 87111 | 2016-12-22 |
| 1871036202 | Shobha Jagannath | Nurse Practitioner | 10700 Academy Rd Ne Apt 216, Albuquerque, NM 87111 | 2016-12-03 |
| 1508319310 | Mariana Boitano | Licensed Practical Nurse | 5400 Gibson Blvd., Albuquerque, NM 87111 | 2016-07-28 |
| 1184011082 | Adam Halpern | Specialist/Technologist | 4204 Parsifal St, Albuquerque, NM 87111 | 2015-04-20 |
| 1083015770 | Cvs Pharmacy | Public Health or Welfare | 5516 Camino Arbustos Ne, Albuquerque, NM 87111 | 2014-09-12 |
| 1508276973 | Stephanie Gonzales | Physician Assistant | 12241 Academy Rd Ne Ste 204, Albuquerque, NM 87111 | 2014-05-06 |
| Find all providers in zip 87111 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124512488 | Stacey Montano Dds LLC | Clinic/Center | 3901 Georgia St Ne Ste G1, Albuquerque, NM 87110-1388 | 2018-06-20 |
| 1003300393 | Napa Dental Management, LLC | Clinic/Center | 10820 Comanche Rd Ne Ste D, Albuquerque, NM 87111-3983 | 2018-06-19 |
| 1871042457 | Dental House Trade Winds, LLC | Clinic/Center | 5400 Central Ave Se, Suite C-101, Albuquerque, NM 87108-1502 | 2016-09-24 |
| 1528437258 | Anywhere Dental Care | Clinic/Center | 28 Canada De Los Alamos Trl Se, Albuquerque, NM 87123-9504 | 2015-09-23 |
| 1871961045 | Gregory R Mcallister, Dds, LLC | Clinic/Center | 5910 Cubero Dr Ne Ste B, Albuquerque, NM 87109-3868 | 2015-09-04 |
| 1003299173 | Sunshine Dental, PC | Clinic/Center | 10411 Lagrima De Oro Rd Ne, Albuquerque, NM 87111-3727 | 2015-07-07 |
| 1356690788 | Alegre Dental | Clinic/Center | 2116 Vista Oeste Nw #202, Albuquerque, NM 87120 | 2012-08-30 |
| 1215243985 | Dr. David J Harnick D.d.s.,m.s.d. | Clinic/Center | 8631 Golf Course Rd Nw Ste F, Albuquerque, NM 87114-6347 | 2010-08-19 |
| 1932332285 | Stephen A. Wagner Dds,pc | Clinic/Center | 801 Encino Pl Ne Ste A3, Albuquerque, NM 87102-2639 | 2009-09-02 |
| 1447427513 | Uptown Park Dental Practice, LLC | Clinic/Center | 2100 Louisiana Blvd Ne, Suite 104, Albuquerque, NM 87110-5419 | 2008-05-08 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87111 |
Please comment or provide details below to improve the information on LEGACY DENTAL LLC.
| 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.