| Legendary Dental Pllc | |
|
1809 21st St Harlan IA 51537-1828 | |
| (712) 340-0333 | |
| Not Available |
| Full Name | Legendary Dental Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1809 21st St, Harlan, Iowa |
| Authorized Official Name and Position | Logan Travis Veath (DENTIST/OWNER) |
| Authorized Official Contact | 7123400333 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legendary Dental Pllc 1809 21st St Harlan IA 51537-1828 Ph: (712) 340-0333 | Legendary Dental Pllc 1809 21st St Harlan IA 51537-1828 Ph: (712) 340-0333 |
| NPI Number | 1114490778 |
|---|---|
| Provider Enumeration Date | 01/07/2019 |
| Last Update Date | 01/07/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114490778 | NPI | - | NPPES |
| 1366821183 | Medicaid | IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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