| Legendary Orthodontics, Llc | |
|
3225 Audubon Dr Laurel MS 39440-1422 | |
| (601) 778-0367 | |
| (601) 340-3162 |
| Full Name | Legendary Orthodontics, Llc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 3225 Audubon Dr, Laurel, Mississippi |
| Authorized Official Name and Position | Kevin Douglas (OWNER) |
| Authorized Official Contact | 9546005027 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legendary Orthodontics, Llc 3225 Audubon Dr Laurel MS 39440-1422 Ph: (601) 778-0367 | Legendary Orthodontics, Llc 3225 Audubon Dr Laurel MS 39440-1422 Ph: (601) 778-0367 |
| NPI Number | 1508359340 |
|---|---|
| Provider Enumeration Date | 06/06/2018 |
| Last Update Date | 06/06/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508359340 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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