LEGENDARY ORTHODONTICS, LLC (NPI# 1508359340) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508359340 |
| Entity Type | Organization |
| Organization Name | LEGENDARY ORTHODONTICS, LLC |
| Practice Address |
3225 Audubon Dr Laurel MS 39440-1422 |
| Practice Telephone | 6017780367 |
| Practice Fax Number | 6013403162 |
| Mailing Telephone | 6017780367 |
| Mailing Fax Number | 6013403162 |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2018-06-06 |
| Authorized Official Name | DR. KEVIN DOUGLAS (OWNER) |
| Authorized Official Telephone | 9546005027 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
Dental Providers |
| Street Address |
3225 AUDUBON DR |
| City | LAUREL |
| State | MS |
| Zip Code | 39440-1422 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306323159 | Tender Loving Care Homecare LLC | Homemaker | 509 Central Ave Ste 224, Laurel, MS 39440 | 2018-07-24 |
| 1669837910 | Laurel Dental Properties | Dentist | 1925 Pine Belt Drive, Laurel, MS 39440 | 2015-12-30 |
| 1215282991 | South Central Regional Medical Center | Clinic/Center | 525 Wayne Drive, Laurel, MS 39440 | 2012-07-18 |
| 1568721215 | Terry Ratcliff Perkins | Counselor | 5192 Hwy 11 North, Laurel, MS 39440 | 2012-05-15 |
| 1437453057 | Alexander Milne Home for Women | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 616 East 19th Street, Laurel, MS 39440 | 2010-12-23 |
| 1710135629 | Jeffrey R. Moffett | Nurse Practitioner | 3115 Audubon Dr, Laurel, MS 39440 | 2008-09-04 |
| 1003096785 | Family Health Center, Inc | Obstetrics & Gynecology | 103 S. 12th Avenue, Laurel, MS 39440 | 2007-11-09 |
| 1669672143 | Laurel Urology Clinic Pa | Urology | 304 S 10th Ave, Laurel, MS 39440 | 2007-07-23 |
| 1093912370 | Tanweer Hussain Majid | Surgery | 1007 Jefferson Street, Laurel, MS 39440 | 2007-06-29 |
| 1780889923 | Hattiesburg Eye Clinic, Pa | Ophthalmology | 1431 North 10th St, Suite 1, Laurel, MS 39440 | 2007-06-18 |
| Find all providers in zip 39440 | ||||
| Taxonomy Code | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922214261 | Robert G Ray | Dentist | 918 Fairlawn Ave, Laurel Shopping Center, Laurel, MD 20707-4806 | 2007-05-15 |
| 1104043611 | David Osburn Hughes Sr. | Dentist | 140 S 15th Ave, Laurel, MS 39440-4124 | 2007-04-19 |
| 1023142171 | Jeffrey Stuart Leblanc | Dentist | 1500 W 12th St, Laurel, MS 39440-2654 | 2007-03-14 |
| 1407839244 | Alan R Heller | Dentist | 9811 Mallard Dr Ste 201, Laurel, MD 20708-3199 | 2005-11-25 |
| 1598373383 | Atefeh Rezaei Boroun | Dentist | 13600 Baltimore Ave Ste 200, Laurel, MD 20707-9495 | 2020-07-17 |
| 1043863186 | Family Orthodontics of Maryland LLC | Dentist | 13600 Baltimore Ave Ste 200, Laurel, MD 20707-9495 | 2019-07-18 |
| 1215432463 | Laurel Orthodontic Associates LLC | Dentist | 3228 Old Bay Springs Rd, Laurel, MS 39440-1453 | 2018-03-29 |
| 1215275425 | Jocelyn Beville Defoe | Dentist | 14333 Laurel Bowie Rd, Ste 201, Laurel, MD 20708-1126 | 2013-01-22 |
| 1316236813 | Decker & Lavine, Dds, Pa | Dentist | 14333 Laurel Bowie Rd, Suite 201, Laurel, MD 20708-1126 | 2011-04-05 |
| 1679775753 | Robert G. Ray D.m.d PC | Dentist | 918 Fairlawn Ave, Laurel, MD 20707-4806 | 2007-06-01 |
| Find all providers in LAUREL | ||||
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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.