Provider Demographics
NPI:1194899229
Name:LEGONITTE, ROBERT (DDO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:LEGONITTE
Suffix:
Gender:M
Credentials:DDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 BOONE BLVD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182
Mailing Address - Country:US
Mailing Address - Phone:703-734-1095
Mailing Address - Fax:703-714-9330
Practice Address - Street 1:1800 BOONE BLVD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182
Practice Address - Country:US
Practice Address - Phone:703-734-1095
Practice Address - Fax:703-714-9330
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA50111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice