# LEGACY FAMILY DENTAL CARE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598150286
- **Authorized official:** MS. CHRISTINE ELAINE GIBBON (OFFICE MANAGER)
- **Authorized official phone:** (208) 773-1559

## Contact information

- **Practice address:** 801 E MEDICAL CT, POST FALLS, ID 83854-7298
- **Practice address phone:** (208) 773-1559
- **Practice address fax:** (208) 773-9959
- **Mailing address:** 801 E MEDICAL CT, POST FALLS, ID 83854-7298
- **Mailing address phone:** (208) 773-1559
- **Mailing address fax:** (208) 773-9959

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D4275 | ID | Yes |

## Other

- **Enumeration date:** 03/31/2015
- **Last updated:** 11/11/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1093949133 | DENTAL | ID |