NPIMap

Organization Active NPI

Legacy Dental P.C.

  • General Practice Dentistry
  • Omaha, NE
National Provider Identifier
1720144967
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5969 Issued in NE
Legal business name
LEGACY DENTAL P.C.
Practice address
17602 Wright St
Suite 105
Omaha, NE 68130-2097
Phone
(402) 393-1108
Fax
(402) 393-1184
NPI assigned
Dec 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Phillip Tracy Brigden, D.D.S.
Title
President
Phone
(402) 393-1108

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 5969 NE Primary

Addresses

Primary practice location

17602 Wright St
Suite 105
Omaha, NE 68130-2097

Mailing address

17602 Wright St
Suite 105
Omaha, NE 68130-2097
Phone (402) 393-1108

National Provider Directory

National Provider Directory

Locations

17602 Wright St
Ste 105
Omaha, NE 68130
Phone (402) 393-1108

NPI Registry JSON

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

{
    "created_epoch": "1167436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720144967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17602 WRIGHT ST",
            "address_2": "SUITE 105",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681302097",
            "telephone_number": "402-393-1108",
            "fax_number": "402-393-1184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17602 WRIGHT ST",
            "address_2": "SUITE 105",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681302097",
            "telephone_number": "402-393-1108",
            "fax_number": "402-393-1184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY DENTAL P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRIGDEN",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "TRACY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-393-1108",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": "5969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.