Organization
THE LEGACY DENTAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN KEITH BOOKOUT DMD (OWNER/DENTIST)
(912) 389-0638
Entity
Organization
Contact information
Practice address
444 N BELAIR RD STE 101, EVANS, GA 30809-3002
(762) 218-2186
(762) 200-2302
Mailing address
4847 HIGH MEADOWS DR, GROVETOWN, GA 30813-8103
(912) 389-0638
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/04/2023
Last updated
03/20/2025
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