Individual
DR. LARRY D LEGACIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
323 A MAIN STREET, EDMORE, ND 58330-0247
(701) 644-2254
(701) 644-2254
Mailing address
PO BOX 247, EDMORE, ND 58330-0247
(701) 644-2254
(701) 644-2254
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1611
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1611
DENTAL STATE LICENSE
ND
05
—
40723
—
ND
Enumeration date
11/01/2006
Last updated
07/08/2007
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