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General NPI Number Information
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NPI Number | 1689594731
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Entity Type | Organization
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Legal Business Name | LEGACY DENTAL GROUP LLC
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Dates
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Enumeration Date | 07/20/2026
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Last Update Date | 07/20/2026
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Provider Practice Location Address
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Address Line | 11 ATLANTIC AVE
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City | MARBLEHEAD
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State | MA
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Zip | 01945-5613
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Country | US
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Telephone | 718-757-6954
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Fax |
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Provider Business Mailing Address
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Address Line | 11 EUGENE DR
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City | WINCHESTER
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State | MA
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Zip | 01890-1062
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. CHRISTOPHER JON LUCIDO
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Credential | DMD
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Telephone | 718-757-6954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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