| Legacy Dental | |
|
5343 Wyoming Blvd Ne Ste A Albuquerque NM 87109-3199 | |
| (505) 822-8777 | |
| Not Available |
| Full Name | Legacy Dental |
|---|---|
| Speciality | Dentist |
| Location | 5343 Wyoming Blvd Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Stewart Anderson (PARTNER) |
| Authorized Official Contact | 5053146526 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Dental 5343 Wyoming Blvd Ne Ste A Albuquerque NM 87109-3199 Ph: (505) 822-8777 | Legacy Dental 5343 Wyoming Blvd Ne Ste A Albuquerque NM 87109-3199 Ph: (505) 822-8777 |
| NPI Number | 1295277903 |
|---|---|
| Provider Enumeration Date | 11/11/2016 |
| Last Update Date | 11/11/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295277903 | NPI | - | NPPES |
| 01076370 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DD3103 (New Mexico) | Primary |
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