Legacy Smiles Family Dental, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3220 Issued in ID

Legal business name

LEGACY SMILES FAMILY DENTAL, PLLC

Practice address

1180 N Olive Ave
Meridian, ID 83642-5920

Phone

(208) 888-3311

Fax

(208) 888-1691

NPI assigned

Aug 16, 2006

Last updated

May 12, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brad J Williams, DDSNPI 1982827952

Title

Partner

Phone

(208) 888-3311

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 2

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.

• Brad J Williams, DDS

  • General Practice Dentistry
  • Meridian, ID
  • NPI 1982827952
  NPD (past) Authorized official
• John Driggs McMurray, DDS

  • Dentist
  • Meridian, ID
  • NPI 1245268598
  NPD (past)

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463011200000",
    "number": "1275646259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 N OLIVE AVE",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425920",
            "telephone_number": "208-888-3311",
            "fax_number": "208-888-1691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 N OLIVE AVE",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425920",
            "telephone_number": "208-888-3311",
            "fax_number": "208-888-1691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY SMILES FAMILY DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2016-05-12",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "208-888-3311",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002799600",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002799500",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806233700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Legacy Primary Care, LLC
• Jeremiah S Legg, LCSW
• Legion Medical LLC (Embrace Psychiatry)
• Diann Lei, BA
• Maria Leibler, DPT
• Lejax Holdings, LLC (DBA Snake River Acupuncture, Pain Relief and Rehabilitation)

• General Practice Dentistry in Meridian, ID
• Providers in Meridian, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2016; 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.