| Legacy Dental | |
|
1685 Pancheri Dr Idaho Falls ID 83402-3169 | |
| (208) 523-0840 | |
| (208) 523-0921 |
| Full Name | Legacy Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1685 Pancheri Dr, Idaho Falls, Idaho |
| Authorized Official Name and Position | Oliver Oneal Thuernagle (DENTIST) |
| Authorized Official Contact | 2085230840 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Dental 4935 Jupiter Hills Dr Idaho Falls ID 83401-6344 Ph: (208) 528-7537 | Legacy Dental 1685 Pancheri Dr Idaho Falls ID 83402-3169 Ph: (208) 523-0840 |
| NPI Number | 1841204609 |
|---|---|
| Provider Enumeration Date | 07/28/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841204609 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D-3902 (Idaho) | Primary |
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