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Organization
R. BROOKS LEGG JR.
Active
Organization
R. BROOKS LEGG JR.
Active
Other names
Clay Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL BROOKS LEGG JR. D.D.S. (OWNER)
(304) 587-4232
Entity
Organization
Contact information
Practice address
63 CARR ST, CLAY, WV 25043-0000
(304) 587-4232
(304) 587-2092
Mailing address
63 CARR ST, P.O BOX 568, CLAY, WV 25043-9402
(304) 587-4232
(304) 587-2092
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
WV2123
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810005754
—
WV
Enumeration date
10/18/2006
Last updated
06/18/2008
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