NPIMap

Organization Active NPI

Legacy Dental Group

  • Dentist
  • Edmond, OK
National Provider Identifier
1831587575
Registry record updated Jan 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
OK4913 Issued in OK
Legal business name
LEGACY DENTAL GROUP
Practice address
3901 E Covell
Edmond, OK 73034
Phone
(405) 513-6630
Fax
(405) 359-9647
NPI assigned
Jan 5, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2015

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

Authorized official

Name
Ashley Dussault
Title
Office Manager
Phone
(405) 513-6630

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X OK4913 OK Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X OK6256 OK

Addresses

Primary practice location

3901 E Covell
Edmond, OK 73034

Mailing address

3901 E Covell
Edmond, OK 73034
Phone (405) 513-6630

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1420416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420588800000",
    "number": "1831587575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 E COVELL",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "73034",
            "telephone_number": "405-513-6630",
            "fax_number": "405-359-9647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 E COVELL",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "73034",
            "telephone_number": "405-513-6630",
            "fax_number": "405-359-9647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-05",
        "last_updated": "2015-01-07",
        "status": "A",
        "authorized_official_last_name": "DUSSAULT",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "405-513-6630"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "OK",
            "license": "OK4913",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "OK",
            "license": "OK6256",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2015; 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.