MEDICARE: DR. CHRISTINA JACQUELIN LEGRADI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	27153	FL
2	122300000X	Dentist	DN27153	FL
3	122300000X	Dentist	D.007299-C1	AL

General Provider Information

NPI Number	:	1184356404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA JACQUELIN LEGRADI DMD

Provider Business Mailing Address
First Line	:	1605 COGSWELL AVE
Second Line	:
City	:	PELL CITY
State	:	AL
Zip	:	35125-1644
Country	:	US
Telephone Number	:	205-884-2370
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 COGSWELL AVE
Second Line	:
City	:	PELL CITY
State	:	AL
Zip	:	35125-1644
Country	:	US
Telephone Number	:	205-884-2370
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	06/11/2024

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