NPI Registry.org

Legacy Dental Llc

NPI Registration Record

Provider / OrganizationNPIDate Certified
LEGACY DENTAL LLC16791755412020-11-14
Entity TypeOrganization
Provider OrganizationLEGACY DENTAL LLC
Practice Office Address6025 MILL STONE DR
FAIRVIEW, PA US
Practice Office Telephone8144507999
Mailing Address6025 MILL STONE DR
FAIRVIEW, PA 164152247 US
Business Telephone8144507999
Authorized OfficialSAMER MANSOUR, DENTIST
8144507999
HPT Codes
CodeLicense NoState
1223D0001X PRIMARY
193400000X SINGGroup Code
OPI Codes
Governmental Registrations [CAGE/NCAGE/DUNS]

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