Organization
LEGACY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRIS WITTUSEN (DIRECTOR)
(561) 381-3100
Entity
Organization
Contact information
Practice address
4993 W ATLANTIC AVE, DELRAY BEACH, FL 33445-3850
(561) 381-3100
(561) 381-3323
Mailing address
4993 W ATLANTIC AVE, DELRAY BEACH, FL 33445-3850
(561) 381-3100
(561) 381-3323
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
FL
Other
Enumeration date
12/28/2010
Last updated
12/28/2010
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