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LEGACY DENTAL ASSOCIATES
NPI 1639030307
Dentist - General Practice in Grand Rapids, MI

Active since November 20, 2025
2440 GAYNOR AVE NW, GRAND RAPIDS, MI 49544(616) 784-8444 Get Directions Write a Review

NPPES record last updated: November 20, 2025. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Legacy Dental Associates NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LEGACY DENTAL ASSOCIATES (NPI 1639030307) is a healthcare organization registered as a general practice in Grand Rapids, Michigan and active in the NPI registry since November 2025. The organization lists Jakob Lee, Dentist, as its authorized official.

NPPES Registry Identity

NPI1639030307
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameLEGACY DENTAL ASSOCIATES
Location Address2440 GAYNOR AVE NWGrand Rapids, MI 49544-1830
Mailing Address2716 Sterner St NwGrand Rapids, MI 49504-8100 · (616) 558-7928
Phone(616) 784-8444
Organization SubpartNo
Authorized OfficialJakob LeeDentist · (616) 558-7928
Enumeration DateNovember 20, 2025
NPPES CertifiedNovember 20, 2025
✔ NPI 1639030307 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
2440 GAYNOR AVE NW, Grand Rapids, MI 49544
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARK E PETERSON, DDS
Dentist (General Practice)
2440 GAYNOR AVE NW
GRAND RAPIDS, MI 49544
Kent County (616) 784-8444

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Legacy Dental Associates's NPI number?

The NPI number for Legacy Dental Associates is 1639030307. It was assigned to this organization in the NPPES registry on November 20, 2025.

Where is Legacy Dental Associates located?

Legacy Dental Associates is located at 2440 Gaynor Ave NW, Grand Rapids, MI 49544. The listed phone number is (616) 784-8444.

What is Legacy Dental Associates's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Legacy Dental Associates was last updated on November 20, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.