NPIMap

Organization Active NPI

Legacy Smiles, LLP

Doing business as Legacy Smiles

  • General Practice Dentistry
  • Peoria, AZ
National Provider Identifier
1609052042
Registry record updated Sep 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LEGACY SMILES, LLP
Doing business as
Legacy Smiles
Practice address
28451 North Vistancia Blvd
Suite 101
Peoria, AZ 85383
Phone
(623) 218-6638
Fax
(623) 218-6937
NPI assigned
Jan 16, 2008
Last updated
Sep 7, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2010

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

Authorized official

Name
Dr. Paul Gebhart, DDS
Title
Owner Doctor
Phone
(623) 218-6638

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

28451 North Vistancia Blvd
Suite 101
Peoria, AZ 85383

Mailing address

2860 Michelle
2ND Floor
Irvine, CA 92606-1009
Phone (714) 508-3600

Other names 1

  • Legacy Smiles Doing business as

National Provider Directory

National Provider Directory

Locations

28451 N Vistancia Blvd
Ste 101
Peoria, AZ 85383
Phone (623) 218-6638

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": "1200441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283817600000",
    "number": "1609052042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2860 MICHELLE",
            "address_2": "2ND FLOOR",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926061009",
            "telephone_number": "714-508-3600",
            "fax_number": "714-368-2092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28451 NORTH VISTANCIA BLVD",
            "address_2": "SUITE 101",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "85383",
            "telephone_number": "623-218-6638",
            "fax_number": "623-218-6937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY SMILES, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-16",
        "last_updated": "2010-09-07",
        "status": "A",
        "authorized_official_last_name": "GEBHART",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "OWNER DOCTOR",
        "authorized_official_telephone_number": "623-218-6638",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2010; 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.