LEGACY DENTAL, P.C. (NPI# 1811283302) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811283302 |
| Entity Type | Organization |
| Organization Name | LEGACY DENTAL, P.C. |
| Practice Address |
4409 Sw 9th St Des Moines IA 50315-3909 |
| Practice Telephone | 5152858888 |
| Practice Fax Number | 5152877760 |
| Mailing Telephone | 5152858888 |
| Mailing Fax Number | 5152877760 |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2011-11-03 |
| Authorized Official Name | DR. JEFFREY WAYNE PURK (OWNER) |
| Authorized Official Telephone | 5152858888 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QS0112X |
Clinic/Center Specialization: Oral and Maxillofacial Surgery |
7566 | IA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | 1083827117 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Iowa Business Entities | LEGACY DENTAL, P.C. | 4409 Sw 9th Street, Des Moines, IA 50315 |
| Street Address |
4409 SW 9TH ST |
| City | DES MOINES |
| State | IA |
| Zip Code | 50315-3909 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881749893 | Emergency Dental Care Usa | Dentist | 4409 Sw 9th St, Des Moines, IA 50315 | 2007-01-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326580606 | Stacie Brown | Specialist/Technologist | 1201 Herold Ave, Des Moines, IA 50315 | 2016-11-17 |
| 1245581560 | Stroke Detections Plus, Inc. | Early Intervention Provider Agency | 2407 Sw 9th Street, Des Moines, IA 50315 | 2012-09-26 |
| 1922371533 | Ronald D. Sanford | Durable Medical Equipment & Medical Supplies | 1920-s.w. Frazier, Des Moines, IA 50315 | 2012-02-13 |
| 1811155203 | Katherine M Schultz | Occupational Therapy Assistant | 4911 Sw 19th, Des Moines, IA 50315 | 2008-06-02 |
| 1255599635 | Lisa Kaye Malsom | Physical Therapist | 4911 Sw 19th Street, Des Moines, IA 50315 | 2008-06-02 |
| 1346445350 | Herbert Lawrence Notch | Psychologist | 7510 Sw 9th, Des Moines, IA 50315 | 2007-06-19 |
| 1114947132 | Richard Alan Lyman | Dentist | 6100 Sw 9th St, Des Moines, IA 50315 | 2006-07-20 |
| 1487603684 | Eye Care of Iowa PC | Optometrist | 200 Army Post Rd, Des Moines, IA 50315 | 2006-05-08 |
| 1437115920 | Hearing Aid Centers Inc. | Hearing Aid Equipment | 1219 Sw Army Post Rd, Des Moines, IA 50315 | 2006-04-24 |
| 1811958879 | Mitzi Buck | Physical Therapist | 1050 E Army Post Road, Suite E & F, Des Moines, IA 50315 | 2006-03-30 |
| Find all providers in zip 50315 | ||||
| Taxonomy Code | 261QS0112X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730355033 | Clinton Dental Surgery Center, P.C. | Clinic/Center | 2314 N 2nd St, Clinton, IA 52732-2434 | 2008-05-06 |
| 1336328509 | Ames Oral Surgeons, P.C. | Clinic/Center | 1212 Duff Ave, Ames, IA 50010-5467 | 2007-10-24 |
| 1851453369 | Oral & Maxillofacial Surgery Assoc PC | Clinic/Center | 116 E 11th St, Suite 201, Spencer, IA 51301-4364 | 2006-12-14 |
| 1992799811 | Great River Oral and Maxillofacial Surgery PC | Clinic/Center | 100 Bryant St, Dubuque, IA 52003-7405 | 2005-09-07 |
| City | DES MOINES |
| Zip Code | 50315 |
Please comment or provide details below to improve the information on LEGACY DENTAL, P.C..
| 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.