MEDICARE: DR. PAUL J. LEGUNN D.D.S.

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	1223E0200X	Endodontics	36233	NY

General Provider Information

NPI Number	:	1144316852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL J. LEGUNN D.D.S.

Provider Business Mailing Address
First Line	:	345 NORTH MAIN STREET
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-4305
Country	:	US
Telephone Number	:	845-634-7696
Fax Number	:

Provider Business Practice Location Address
First Line	:	345 NORTH MAIN STREET
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-4305
Country	:	US
Telephone Number	:	845-634-7696
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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