Provider Demographics
NPI:1295276541
Name:LEGGETT, JEFFREY (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:LEGGETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 STERLING CIR
Mailing Address - Street 2:APT 207
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-2119
Mailing Address - Country:US
Mailing Address - Phone:828-442-3521
Mailing Address - Fax:
Practice Address - Street 1:1448 W FILLMORE ST UNIT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4616
Practice Address - Country:US
Practice Address - Phone:828-442-3521
Practice Address - Fax:828-442-3521
Is Sole Proprietor?:No
Enumeration Date:2017-03-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILHAVE NOT RECEIVED122300000X
IL019031138122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist