Provider Demographics
NPI:1063880441
Name:LEGAKO, KASSIDY E (DDS)
Entity type:Individual
Prefix:DR
First Name:KASSIDY
Middle Name:E
Last Name:LEGAKO
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 1:6707 NW OAK DALE DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-1261
Mailing Address - Country:US
Mailing Address - Phone:580-678-3713
Mailing Address - Fax:
Practice Address - Street 1:6707 NW OAK DALE DR
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-1261
Practice Address - Country:US
Practice Address - Phone:580-678-3713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK66831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice