Provider Demographics
NPI:1821209388
Name:LEGGOTT, PENELOPE J (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:J
Last Name:LEGGOTT
Suffix:
Gender:F
Credentials:DDS MS
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Other - Credentials:
Mailing Address - Street 1:2210 KULSHAN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2779
Mailing Address - Country:US
Mailing Address - Phone:360-424-3811
Mailing Address - Fax:360-424-8703
Practice Address - Street 1:2210 KULSHAN VIEW DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2779
Practice Address - Country:US
Practice Address - Phone:360-424-3811
Practice Address - Fax:360-424-8703
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WADE000071021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5017173Medicaid
CAD33488OtherDENTAL LICENSE