NPIMap

Organization Active NPI

R. Brooks Legg Jr.

  • General Practice Dentistry
  • Clay, WV
National Provider Identifier
1912088410
Registry record updated Jun 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
WV2123 Issued in WV
Legal business name
R. BROOKS LEGG JR.
Doing business as
Clay Dental Clinic
Practice address
63 Carr St
Clay, WV 25043-0000
Phone
(304) 587-4232
Fax
(304) 587-2092
NPI assigned
Oct 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2008

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

Authorized official

Name
Dr. Russell Brooks Legg Jr., D.D.S.NPI 1285673905
Title
Owner
Phone
(304) 587-4232

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X WV2123 WV Primary

Addresses

Primary practice location

63 Carr St
Clay, WV 25043-0000

Mailing address

63 Carr St
P.O Box 568
Clay, WV 25043-9402
Phone (304) 587-4232

Other identifiers 1

IdentifierTypeStateIssuer
3810005754MedicaidWV

Other names 1

  • Clay Dental Clinic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1912088410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 CARR ST",
            "address_2": "P.O BOX 568",
            "city": "CLAY",
            "state": "WV",
            "postal_code": "250439402",
            "telephone_number": "304-587-4232",
            "fax_number": "304-587-2092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 CARR ST",
            "city": "CLAY",
            "state": "WV",
            "postal_code": "250430000",
            "telephone_number": "304-587-4232",
            "fax_number": "304-587-2092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R. BROOKS LEGG JR.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "LEGG",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "BROOKS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-587-4232",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WV",
            "license": "WV2123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810005754",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clay Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clay, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; 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.