Provider Demographics
NPI:1275834483
Name:LEGACY DENTAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:LEGACY DENTAL ASSOCIATES, P.C.
Other - Org Name:LEGACY RANCH DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTAL PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-335-9313
Mailing Address - Street 1:4851 LEGACY DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0816
Mailing Address - Country:US
Mailing Address - Phone:972-335-9313
Mailing Address - Fax:972-335-9135
Practice Address - Street 1:4851 LEGACY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-0816
Practice Address - Country:US
Practice Address - Phone:972-335-9313
Practice Address - Fax:972-335-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty