Provider Demographics
NPI:1407319213
Name:LEGACY DENTAL OF BEAUMONT PLLC
Entity Type:Organization
Organization Name:LEGACY DENTAL OF BEAUMONT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:409-241-8383
Mailing Address - Street 1:6480 EASTEX FWY STE A
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708-4336
Mailing Address - Country:US
Mailing Address - Phone:409-241-8383
Mailing Address - Fax:409-241-8384
Practice Address - Street 1:6480 EASTEX FWY STE A
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708-4336
Practice Address - Country:US
Practice Address - Phone:832-725-9895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty