Organization Active NPI

Legacy Mobile Dentistry LLC

  • Dentist
  • Oregon, OH
National Provider Identifier
1558216804
Registry record updated Jul 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
LEGACY MOBILE DENTISTRY LLC
Practice address
2737 Navarre Ave Ste 203
Oregon, OH 43616-3276
Phone
(419) 728-9998
NPI assigned
Mar 2, 2026
Last updated
Jul 21, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2026

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

Authorized official

Name
Nesreen Aouthmany, DDSNPI 1770139768
Title
Managing Member
Phone
(419) 728-9998

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

2737 Navarre Ave Ste 203
Oregon, OH 43616-3276

Mailing address

2737 Navarre Ave Ste 203
Oregon, OH 43616-3276
Phone (419) 728-9998

National Provider Directory

National Provider Directory

Locations

2737 Navarre Ave
Ste 203
Oregon, OH 43616
Phone (419) 540-1873

Practitioners & affiliated clinicians

Practitioners 1

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": "1772409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784592000000",
    "number": "1558216804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2737 NAVARRE AVE STE 203",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163276",
            "telephone_number": "419-728-9998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2737 NAVARRE AVE STE 203",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163276",
            "telephone_number": "419-728-9998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY MOBILE DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-03-02",
        "last_updated": "2026-07-21",
        "certification_date": "2026-07-21",
        "status": "A",
        "authorized_official_last_name": "AOUTHMANY",
        "authorized_official_first_name": "NESREEN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "419-728-9998",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oregon, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2026; 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.