Provider Demographics
NPI:1043662943
Name:LEGG, HOLLY TODD (DDS)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:TODD
Last Name:LEGG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 WINDING RIVER LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-3569
Mailing Address - Country:US
Mailing Address - Phone:434-984-6400
Mailing Address - Fax:
Practice Address - Street 1:320 WINDING RIVER LN
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-3569
Practice Address - Country:US
Practice Address - Phone:434-984-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415254122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist