The Legacy Dental Group, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

THE LEGACY DENTAL GROUP, LLC

Practice address

444 N Belair Rd Ste 101
Evans, GA 30809-3002

Phone

(762) 218-2186

Fax

(762) 200-2302

NPI assigned

Dec 4, 2023

Last updated

Mar 20, 2025By 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

Dr. Jonathan Keith Bookout, DMDNPI 1861874638

Title

Owner/Dentist

Phone

(912) 389-0638

Specialties & licenses 1

Addresses

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.

• Jonathan Keith Bookout, D.M.D.

  • Dentist
  • Evans, GA
  • NPI 1861874638
  NPD Authorized official

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

{
    "created_epoch": "1701648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742428800000",
    "number": "1578330197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4847 HIGH MEADOWS DR",
            "city": "GROVETOWN",
            "state": "GA",
            "postal_code": "308138103",
            "telephone_number": "912-389-0638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 N BELAIR RD STE 101",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308093002",
            "telephone_number": "762-218-2186",
            "fax_number": "762-200-2302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LEGACY DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-04",
        "last_updated": "2025-03-20",
        "certification_date": "2025-03-20",
        "status": "A",
        "authorized_official_last_name": "BOOKOUT",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "912-389-0638",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Evans, GA
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• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2025; 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.