Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 6127C1 | AL |
Y | 1223D0001X | Dental Public Health | DN22744 | FL |
NPI | 1487062857 |
---|---|
Provider Name | Samuel Martin Leggitt |
First Address | Sarasota, FL 34232-6418 |
Second Address | Sarasota, FL 34232-6418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2014 |
Last Update Date | 25/07/2017 |