Legacy Dental Practice PLLC

Primary specialty

DentistTaxonomy code 122300000X

License

053408 Issued in NY

Legal business name

LEGACY DENTAL PRACTICE PLLC

Practice address

190 Ferguson Dr
Hilton, NY 14468-9504

Phone

(585) 720-1370

NPI assigned

Aug 4, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gary Louis Gusmerotti, DDS

Title

President

Phone

(585) 720-1370

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217808000000",
    "number": "1063678613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 ERIE CANAL DR",
            "address_2": "SUITE H",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146264602",
            "telephone_number": "585-720-1370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 FERGUSON DR",
            "city": "HILTON",
            "state": "NY",
            "postal_code": "144689504",
            "telephone_number": "585-720-1370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY DENTAL PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-04",
        "last_updated": "2008-08-04",
        "status": "A",
        "authorized_official_last_name": "GUSMEROTTI",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "585-720-1370",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "053408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1477611432",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katie L Kunkle, LCSW
• Sherri Kurtz, BSDH
• Garth Laidlaw, MD
• Lakeside Health System
• Matthew Landon, P.T.
• Mark Lukomskiy, DPT
• Bonnie A Lupo, MS, FNP-C
• Cheryl Macklem
• Rachel L Macmullen, NYS LIC SLP
• Nilsa Milagros Martinez, MD

• Dentist in Hilton, NY
• Providers in Hilton, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.