| Legacy Dental | |
|
3127 Baldwin Park Blvd Suite D Baldwin Park CA 91706-4754 | |
| (626) 962-3500 | |
| (626) 962-3551 |
| Full Name | Legacy Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3127 Baldwin Park Blvd, Baldwin Park, California |
| Authorized Official Name and Position | Daniel Elenes (OWNER) |
| Authorized Official Contact | 3106372600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Dental 3127 Baldwin Park Blvd Suite D Baldwin Park CA 91706-4754 Ph: (626) 962-3500 | Legacy Dental 3127 Baldwin Park Blvd Suite D Baldwin Park CA 91706-4754 Ph: (626) 962-3500 |
| NPI Number | 1841596954 |
|---|---|
| Provider Enumeration Date | 02/07/2011 |
| Last Update Date | 03/01/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841596954 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 30715 (California) | Primary |
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