| Legacy Dental P.c. | |
|
17602 Wright St Suite 105 Omaha NE 68130-2097 | |
| (402) 393-1108 | |
| (402) 393-1184 |
| Full Name | Legacy Dental P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 17602 Wright St, Omaha, Nebraska |
| Authorized Official Name and Position | Phillip Tracy Brigden (PRESIDENT) |
| Authorized Official Contact | 4023931108 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Dental P.c. 17602 Wright St Suite 105 Omaha NE 68130-2097 Ph: (402) 393-1108 | Legacy Dental P.c. 17602 Wright St Suite 105 Omaha NE 68130-2097 Ph: (402) 393-1108 |
| NPI Number | 1720144967 |
|---|---|
| Provider Enumeration Date | 12/30/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720144967 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5969 (Nebraska) | Primary |
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