NPIMap

Organization Active NPI

Legacy Dental

  • Preferred Provider Organization
  • Delray Beach, FL
National Provider Identifier
1861796229
Registry record updated Dec 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
Legal business name
LEGACY DENTAL
Practice address
4993 W Atlantic Ave
Delray Beach, FL 33445-3850
Phone
(561) 381-3100
Fax
(561) 381-3323
NPI assigned
Dec 28, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2010

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

Authorized official

Name
Mr. Chris Wittusen
Title
Director
Phone
(561) 381-3100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X FL Primary

Addresses

Primary practice location

4993 W Atlantic Ave
Delray Beach, FL 33445-3850

Mailing address

4993 W Atlantic Ave
Delray Beach, FL 33445-3850
Phone (561) 381-3100

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1293494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1293494400000",
    "number": "1861796229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4993 W ATLANTIC AVE",
            "city": "DELRAY BEACH",
            "state": "FL",
            "postal_code": "334453850",
            "telephone_number": "561-381-3100",
            "fax_number": "561-381-3323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4993 W ATLANTIC AVE",
            "city": "DELRAY BEACH",
            "state": "FL",
            "postal_code": "334453850",
            "telephone_number": "561-381-3100",
            "fax_number": "561-381-3323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-28",
        "last_updated": "2010-12-28",
        "status": "A",
        "authorized_official_last_name": "WITTUSEN",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "561-381-3100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Delray Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 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.