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Organization
LEGACY DENTAL GROUP PLLC
Active
Organization
LEGACY DENTAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN V KERR DMD (OWNER)
(253) 584-6200
Entity
Organization
Contact information
Practice address
9951 MICKELBERRY RD NW, SUITE #215, SILVERDALE, WA 98383-8309
(360) 692-9701
Mailing address
9951 MICKELBERRY RD NW, SUITE #215, SILVERDALE, WA 98383-8309
(360) 692-9701
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0300X
Periodontics
—
NULL
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
09/20/2012
Last updated
09/20/2012
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