Provider Demographics
NPI:1336744127
Name:LEGACY DENTAL PC
Entity Type:Organization
Organization Name:LEGACY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARROW
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-843-7570
Mailing Address - Street 1:409 POND ST STE 7
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-6853
Mailing Address - Country:US
Mailing Address - Phone:781-843-7570
Mailing Address - Fax:781-843-3574
Practice Address - Street 1:409 POND ST STE 7
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-6853
Practice Address - Country:US
Practice Address - Phone:781-843-7570
Practice Address - Fax:781-843-3574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty