# LEGACY DENTAL

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1841204609
- **Authorized official:** OLIVER ONEAL THUERNAGLE DMD (DENTIST)
- **Authorized official phone:** (208) 523-0840

## Contact information

- **Practice address:** 1685 PANCHERI DR, IDAHO FALLS, ID 83402-3169
- **Practice address phone:** (208) 523-0840
- **Practice address fax:** (208) 523-0921
- **Mailing address:** 4935 JUPITER HILLS DR, IDAHO FALLS, ID 83401-6344
- **Mailing address phone:** (208) 528-7537

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D-3902 | ID | Yes |

## Other

- **Enumeration date:** 07/28/2006
- **Last updated:** 08/22/2020