| The Legacy Dental Group, Llc | |
|
444 N Belair Rd Ste 101 Evans GA 30809-3002 | |
| (912) 389-0638 | |
| Not Available |
| Full Name | The Legacy Dental Group, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 444 N Belair Rd Ste 101, Evans, Georgia |
| Authorized Official Name and Position | Jonathan Keith Bookout (OWNER/DENTIST) |
| Authorized Official Contact | 9123890638 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Legacy Dental Group, Llc 4847 High Meadows Dr Grovetown GA 30813-8103 Ph: (912) 389-0638 | The Legacy Dental Group, Llc 444 N Belair Rd Ste 101 Evans GA 30809-3002 Ph: (912) 389-0638 |
| NPI Number | 1578330197 |
|---|---|
| Provider Enumeration Date | 12/04/2023 |
| Last Update Date | 12/04/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578330197 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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