National Provider Identifier Database

LEGACY DENTAL PC
Oral and Maxillofacial Surgery

The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.


Contact Information

LEGACY DENTAL, P.C.
4409 SW 9TH ST
DES MOINES, IA50315-3909
Phone: 515-285-8888
Fax: 515-287-7760
Website:
Specialty Taxonomy Code
* Oral and Maxillofacial Surgery 261QS0112X

* Indicates primary specialty

NPI Profile & details for LEGACY DENTAL, P.C.

NPI Number 1811283302
Legal business name
LBN
LEGACY DENTAL, P.C.
Authorized official JEFFREY PURK - (OWNER)
Entity Organization
Organization subpart No
Enumeration date 06/22/2011
Last updated 11/03/2011 - About 15 years ago
Sole proprietor1 Not specified
Identifiers
  • IA License #: 7566
  • IA Medicaid: 1083827117

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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