Individual
MARK LEGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1004 GLEN PAUL CT, SHOREVIEW, MN 55126-8113
(651) 490-1158
Mailing address
1004 GLEN PAUL CT, SHOREVIEW, MN 55126-8113
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D8931
MN
Other
Enumeration date
03/04/2012
Last updated
03/04/2012
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