Organization
LEGACY DENTAL GROUP
Active
Organization
LEGACY DENTAL GROUP
Active
Other names
LOUIS T CORE DDS
Organization subpart
No
Provider details
NPI number
Authorized official
LOUIS CORE (DDS)
(602) 993-4200
Entity
Organization
Contact information
Practice address
18205 N 51ST AVE STE 101, GLENDALE, AZ 85308-1491
(602) 993-4200
(602) 993-4222
Mailing address
POC MANAGEMENT LLC, 3000 W WARNER AVE, SANTA ANA, CA 92704
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
D4729
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0353324
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/14/2006
Last updated
08/22/2020
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