Individual
KENNETH LEGAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5430 E WASHINGTON ST, INDIANAPOLIS, IN 46219-6446
(317) 322-1840
Mailing address
415 N GRAND AVE, PUEBLO, CO 81003-3111
(719) 583-1800
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008504A
IN
Other
Enumeration date
11/10/2006
Last updated
07/09/2007
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