Organization
LEGACY DENTAL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY WAYNE PURK D.D.S. (OWNER)
(515) 285-8888
Entity
Organization
Contact information
Practice address
4409 SW 9TH ST, DES MOINES, IA 50315-3909
(515) 285-8888
(515) 287-7760
Mailing address
4409 SW 9TH ST, DES MOINES, IA 50315-3909
(515) 285-8888
(515) 287-7760
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
7566
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083827117
—
IA
Enumeration date
06/22/2011
Last updated
11/03/2011
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