NPIMap

Organization Active NPI

Legacy Dental, P.C.

  • Oral and Maxillofacial Surgery Clinic/Center
  • Des Moines, IA
National Provider Identifier
1811283302
Registry record updated Nov 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X
License
7566 Issued in IA
Legal business name
LEGACY DENTAL, P.C.
Practice address
4409 SW 9TH St
Des Moines, IA 50315-3909
Phone
(515) 285-8888
Fax
(515) 287-7760
NPI assigned
Jun 22, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2011

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

Authorized official

Name
Dr. Jeffrey Wayne Purk, D.D.S.
Title
Owner
Phone
(515) 285-8888

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X 7566 IA Primary

Addresses

Primary practice location

4409 SW 9TH St
Des Moines, IA 50315-3909

Mailing address

4409 SW 9TH St
Des Moines, IA 50315-3909
Phone (515) 285-8888

Other identifiers 1

IdentifierTypeStateIssuer
1083827117MedicaidIA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320278400000",
    "number": "1811283302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4409 SW 9TH ST",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503153909",
            "telephone_number": "515-285-8888",
            "fax_number": "515-287-7760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4409 SW 9TH ST",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503153909",
            "telephone_number": "515-285-8888",
            "fax_number": "515-287-7760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-22",
        "last_updated": "2011-11-03",
        "status": "A",
        "authorized_official_last_name": "PURK",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "515-285-8888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "IA",
            "license": "7566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083827117",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; 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.