Provider Demographics
NPI:1043317902
Name:LEGGETT, BRENT L (DDS, MS)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:L
Last Name:LEGGETT
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2900 CENTRAL AVE
Mailing Address - Street 2:ORTHODONTIC AND PEDIATRIC CLINIC: BUILDING #2
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-8626
Mailing Address - Country:US
Mailing Address - Phone:406-656-6100
Mailing Address - Fax:
Practice Address - Street 1:601 BROOKMAN DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601
Practice Address - Country:US
Practice Address - Phone:601-833-4912
Practice Address - Fax:601-833-0045
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN88001223X0400X
CO002026701223X0400X
MT79491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics