Provider Demographics
NPI:1235150335
Name:JACK LEGON DMD PA
Entity Type:Organization
Organization Name:JACK LEGON DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-383-5700
Mailing Address - Street 1:40 PARK PL
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-1747
Mailing Address - Country:US
Mailing Address - Phone:973-383-5700
Mailing Address - Fax:973-383-4131
Practice Address - Street 1:40 PARK PL
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1747
Practice Address - Country:US
Practice Address - Phone:973-383-5700
Practice Address - Fax:973-383-4131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10842261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental