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General NPI Number Information
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NPI Number | 1255235644
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Entity Type | Organization
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Legal Business Name | LEGACY DENTAL GROUP, PLLC
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 3309 CUMMINGS HWY STE 112
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City | CHATTANOOGA
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State | TN
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Zip | 37419-2438
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Country | US
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Telephone | 423-821-3279
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Fax |
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Provider Business Mailing Address
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Address Line | 135 TWIN OAKS CT
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City | DAYTON
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State | TN
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Zip | 37321-5979
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Country | US
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Telephone | 423-762-9992
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Fax |
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Authorized Official
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Title or Position | INSURANCE ADMINISTRATOR
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Name | MRS. MARCY KAY
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Credential |
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Telephone | 423-762-9992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | NULL
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