LEGACY FAMILY DENTIST, PLLC. (NPI# 1518250265) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518250265 |
| Entity Type | Organization |
| Organization Name | LEGACY FAMILY DENTIST, PLLC. |
| Practice Address |
8470 Nw Expressway Oklahoma City OK 73162-6009 |
| Practice Telephone | 4057288400 |
| Practice Fax Number | 4057201777 |
| Mailing Telephone | 4057288400 |
| Mailing Fax Number | 4057201777 |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2011-05-26 |
| Authorized Official Name | DR. ALAN FORTENBERRY (MANAGER) |
| Authorized Official Telephone | 4057288400 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
6026 | OK | Ambulatory Health Care Facilities |
| Street Address |
8470 NW EXPRESSWAY |
| City | OKLAHOMA CITY |
| State | OK |
| Zip Code | 73162-6009 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114493319 | Anthony Haislip | Peer Specialist | 6904 Briar Creek Dr., Oklahoma City, OK 73162 | 2018-10-16 |
| 1760973705 | Lars Pederson | Peer Specialist | 7308 Nw 114th St, Oklahoma City, OK 73162 | 2018-05-25 |
| 1770026841 | Cory Chambers | Dentist | 12321 N. Council Rd, Oklahoma City, OK 73162 | 2016-11-22 |
| 1487109062 | K. Williams | Case Manager/Care Coordinator | 10400 North Council Road, Oklahoma City, OK 73162 | 2016-08-24 |
| 1932537669 | Al Dowell | Case Manager/Care Coordinator | 8849 Nw 121st St., Oklahoma City, OK 73162 | 2013-10-15 |
| 1508106378 | Wilvia Wong-plum | Counselor | 7309 N.w. 107th St., Oklahoma City, OK 73162 | 2013-02-15 |
| 1386912301 | Delores Parker | Counselor | 11916 Silvermoon Drive, Oklahoma City, OK 73162 | 2011-12-05 |
| 1518241744 | Victor Njoh | Pharmacist | 7101 West Hefner Rd, Oklahoma City, OK 73162 | 2011-10-06 |
| 1841500113 | Kimmi Jo Stanley | Speech-Language Pathologist | 9400 St. Ann's Home, Oklahoma City, OK 73162 | 2010-10-20 |
| 1548493091 | Glen Knight Wallace | Counselor | 7932 Nicholson, Okalhoma City, OK 73162 | 2009-09-01 |
| Find all providers in zip 73162 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063041275 | Fleming Dental Co Pllc | Clinic/Center | 13316 S Western Ave Ste B, Oklahoma City, OK 73170-7309 | 2020-04-08 |
| 1578103743 | Dental Surgery Center of Midwest City | Clinic/Center | 9060 Harmony Dr Ste E, Oklahoma City, OK 73130-6253 | 2020-01-15 |
| 1053959247 | Phillip J Elassal Dds Pllc | Clinic/Center | 1601 Sw 89th Street #g500, Oklahoma City, OK 73159 | 2019-12-18 |
| 1558902874 | Insight Dental and Implants | Clinic/Center | 3906 Nw 10th St Ste B, Oklahoma City, OK 73107-6060 | 2019-10-08 |
| 1225683311 | I240 Dental | Clinic/Center | 1506 W I 240 Service Rd, Oklahoma City, OK 73159-4126 | 2019-08-06 |
| 1861058877 | Dental Depot of 63rd & Nw Expressway, Pllc | Clinic/Center | 4025 Nw 63rd Street, Oklahoma City, OK 73116 | 2019-05-15 |
| 1285100339 | Moore Dentistry & Braces | Clinic/Center | 1530 Sw 119th St Unit 108, Oklahoma City, OK 73170-4938 | 2018-10-16 |
| 1295254068 | Sih Oklahoma PC | Clinic/Center | 1325 N Walker Ave 547, Oklahoma City, OK 73103-6405 | 2017-09-13 |
| 1851811293 | Red Dirt Orthodontics Pllc | Clinic/Center | 5940 Nw Expressway # 100, Oklahoma City, OK 73132-5101 | 2017-06-27 |
| 1518494384 | Uptown Smiles Pllc | Clinic/Center | 601 Nw 23rd St, Suite 200, Oklahoma City, OK 73103-1415 | 2017-05-11 |
| Find all providers in OKLAHOMA CITY | ||||
| City | OKLAHOMA CITY |
| Zip Code | 73162 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.