Organization
R. BROOKS LEGG JR.
Active
Other names
Clay Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL BROOKS LEGG JR. D.D.S. (OWNER)
(304) 587-4232
Entity
Organization
Contact information
Practice address
63 CARR ST, CLAY, WV 25043-0000
(304) 587-4232
(304) 587-2092
Mailing address
63 CARR ST, P.O BOX 568, CLAY, WV 25043-9402
(304) 587-4232
(304) 587-2092
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
WV2123
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810005754
—
WV
Enumeration date
10/18/2006
Last updated
06/18/2008
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