Legacy Dental Care LLC
Dentist, General Practice in Blaine, MN. Organization (NPI-2).
NPI number1336683036
StatusActive
Last updated in NPPESDec 14, 2016
Details
- NPI
- 1336683036
- Entity type
- Organization (NPI-2)
- Legal business name
- Legacy Dental Care LLC
- Organization subpart
- No
- Enumeration date
- Dec 14, 2016
- Last updated
- Dec 14, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 8455 | MN | Yes |
Practice location
12265 Central Ave NeBlaine, MN 55434-3961
Phone 763-757-1323
Mailing address
12265 Central Ave NeBlaine, MN 55434-3961
Phone 763-757-1323
Authorized official
Dennis L Parvey
Dentist
7637571323
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