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Contact Information

LEGACY DENTAL LLC
7215 ENGLE RD.
FORT WAYNE, IN46804
 Phone: 260-434-1133
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for LEGACY DENTAL LLC

NPI # 1083704019
LBN Legal business name LEGACY DENTAL LLC
Authorized official NATHAN BOJRAB - (CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 10/13/2006
Last updated 08/17/2020 - About 6 years ago
Identifiers
IN License # 12008943
IN License # 12009422
IN License # 12010440
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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