MEDICARE: LEGACY INSTITUTE LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1457141871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY INSTITUTE LLC

Provider Business Mailing Address
First Line	:	1122 S CONWELL ST
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-3965
Country	:	US
Telephone Number	:	307-234-6054
Fax Number	:	307-234-7896

Provider Business Practice Location Address
First Line	:	1771 GOODSTEIN DR
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-6222
Country	:	US
Telephone Number	:	307-234-6054
Fax Number	:	307-234-7896

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. STUART YOUMANS
Credential	:	DDS
Telephone Number	:	307-234-6054

Provider Enumeration Date	:	05/08/2025
Last Update Date	:	05/08/2025

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Directions to “LEGACY INSTITUTE LLC ” Practice Location

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