Healthcare Provider Details

I. General information

NPI: 1689594731
Provider Name (Legal Business Name): LEGACY DENTAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 ATLANTIC AVE
MARBLEHEAD MA
01945-5613
US

IV. Provider business mailing address

11 EUGENE DR
WINCHESTER MA
01890-1062
US

V. Phone/Fax

Practice location:
  • Phone: 718-757-6954
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER JON LUCIDO
Title or Position: OWNER/DOCTOR
Credential: DMD
Phone: 718-757-6954