Provider Demographics
NPI:1487062857
Name:LEGGITT, SAMUEL MARTIN (DDS)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:MARTIN
Last Name:LEGGITT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 FRUITVILLE RD STE 16
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6418
Mailing Address - Country:US
Mailing Address - Phone:989-284-7042
Mailing Address - Fax:
Practice Address - Street 1:5425 FRUITVILLE RD STE 16
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6418
Practice Address - Country:US
Practice Address - Phone:941-343-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6127C1122300000X
FLDN227441223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No122300000XDental ProvidersDentist