Provider Demographics
NPI:1265655898
Name:LEGAULT, ANDRE MAURICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:MAURICE
Last Name:LEGAULT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 W HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-2941
Mailing Address - Country:US
Mailing Address - Phone:817-268-6888
Mailing Address - Fax:817-284-7733
Practice Address - Street 1:455 W HARWOOD RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2941
Practice Address - Country:US
Practice Address - Phone:817-268-6888
Practice Address - Fax:817-284-7733
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice