MEDICARE: DR. MICHAEL V. LEGRAND, D.M.D., P.C.

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1528765039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MICHAEL V. LEGRAND, D.M.D., P.C.

Provider Business Mailing Address
First Line	:	8324 CROSSLAND LOOP
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-8482
Country	:	US
Telephone Number	:	334-279-1166
Fax Number	:

Provider Business Practice Location Address
First Line	:	8324 CROSSLAND LOOP
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-8482
Country	:	US
Telephone Number	:	334-279-1166
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	CHAD HENDRICKS
Credential	:
Telephone Number	:	612-859-0444

Provider Enumeration Date	:	02/14/2023
Last Update Date	:	02/14/2023

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