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LEGACY DENTAL P.C. NPI 1811283302


NPI Information

NPI: 1811283302
Provider Name: LEGACY DENTAL, P.C.
Classification: Clinic/Center - 261QS0112X
Entity Type: Organization

Specialization: Oral and Maxillofacial Surgery

Address:
4409 SW 9TH ST
DES MOINES, IA
ZIP 50315
Phone: (515) 285-8888
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LEGACY DENTAL, P.C. is an oral and maxillofacial surgery clinic center in Des Moines, IA. The provider is an oral and maxillofacial surgery clinic or center specialized in 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. LEGACY DENTAL, P.C. NPI is 1811283302. The provider is registered as an organization entity type.

The provider's business location address is:

4409 SW 9TH ST
DES MOINES, IA
ZIP 50315-909
Phone: (515) 285-8888
Fax: (515) 287-7760

The provider's authorized official is Jeffrey Wayne Purk .
The authorized official title is Owner and has the following contact phone number (515) 285-8888.

The enumeration date for this NPI number is 6/22/2011 and was last updated on 11/3/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QS0112XClinic/CenterOral and Maxillofacial Surgery7566IOWAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11083827117MEDICAIDIOWA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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