Legacy Pedo LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

LEGACY PEDO LLC

Practice address

3903 Jiles Rd NW
#210
Kennesaw, GA 30144-4612

Phone

(770) 590-9050

NPI assigned

Jun 8, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Michael Reznik, DDS

Title

Owner

Phone

(770) 777-7427

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1275955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275955200000",
    "number": "1871813295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3903 JILES RD NW",
            "address_2": "#210",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301444612",
            "telephone_number": "770-590-9050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3903 JILES RD NW",
            "address_2": "#210",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301444612",
            "telephone_number": "770-590-9050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY PEDO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-08",
        "last_updated": "2010-06-08",
        "status": "A",
        "authorized_official_last_name": "REZNIK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-777-7427",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James E Ledoux Sr., D.C.
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• Tarae Lee
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• Legacy Orthodontics II, LLC
• Clarissa Yvonne Lesueur
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• Nina Joyce Levasseur, RDN
• Stacey Levison, FNP-C

• Pediatric Dentistry in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 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.