MEDICARE: LEGACY FAMILY DENTISTRY, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	122300000X	Dentist
2	1223E0200X	Endodontics
3	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1356105423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY FAMILY DENTISTRY, P.C.

Provider Business Mailing Address
First Line	:	224 SHALLOWFORD RD NW
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30504-4171
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	224 SHALLOWFORD RD NW
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30504-4171
Country	:	US
Telephone Number	:	770-536-1170
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	BEN CUTLER
Credential	:
Telephone Number	:	607-743-9474

Provider Enumeration Date	:	02/09/2024
Last Update Date	:	02/09/2024

Similar Medicare Providers

1821091521 — DR. MARY KRISTIN JORGENSEN DDS
Practice Location Address:

224 SHALLOWFORD RD NW
GAINESVILLE, GA
30504-4171

Practice Phone: 770-536-1170
Practice Fax: 770-536-4653

1770669632 — DR. HENRY GRADY GOBLE D.D.S.
Practice Location Address:

224 SHALLOWFORD RD NW
GAINESVILLE, GA
30504-4171

Practice Phone: 770-536-1170
Practice Fax:

1437355740 — HENRY G. GOBLE, D.D.S., P.C.
Practice Location Address:

224 SHALLOWFORD RD NW
GAINESVILLE, GA
30504-4171

Practice Phone: 770-536-1170
Practice Fax: 770-536-4653

1437258829 — DAVID SELMAN MD
Practice Location Address:

9221 SW 42ND LN
GAINESVILLE, FL
32608-4171

Practice Phone: 352-335-0892
Practice Fax:

1487503397 — CHERRY BLOSSOM AUTISM CENTER, LLC
Practice Location Address:

4929 FAWNWOOD DR
GAINESVILLE, GA
30504-8117

Practice Phone: 912-247-0810
Practice Fax:

1568477768 — WALGREEN CO
Practice Location Address:

649 SHALLOWFORD RD NW
GAINESVILLE, GA
30504-4146

Practice Phone: 678-450-8847
Practice Fax:

Directions to “LEGACY FAMILY DENTISTRY, P.C. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.