NPIMap

Organization Active NPI

Legacy Dental LLC

  • General Practice Dentistry
  • Fort Wayne, IN
National Provider Identifier
1083704019
Registry record updated Aug 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12010440 Issued in IN
Legal business name
LEGACY DENTAL LLC
Practice address
7215 Engle Rd.
Fort Wayne, IN 46804
Phone
(260) 434-1133
NPI assigned
Oct 13, 2006
Last updated
Aug 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2020

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

Authorized official

Name
Mr. Nathan James Bojrab
Title
Ceo
Phone
(260) 434-1133

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 12008943 IN
General Practice Dentistry 1223G0001X 12009422 IN
General Practice Dentistry 1223G0001X 12010440 IN Primary

Addresses

Primary practice location

7215 Engle Rd.
Fort Wayne, IN 46804

Mailing address

7215 Engle Rd.
Fort Wayne, IN 46804
Phone (260) 434-1133

Other names 1

  • Ueber & Friederich Dentistry Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597622400000",
    "number": "1083704019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7215 ENGLE RD.",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46804",
            "telephone_number": "260-434-1133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7215 ENGLE RD.",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46804",
            "telephone_number": "260-434-1133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2020-08-17",
        "certification_date": "2020-08-17",
        "status": "A",
        "authorized_official_last_name": "BOJRAB",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "260-434-1133",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12008943",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12009422",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ueber & Friederich Dentistry",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2020; 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.