Healthcare Provider Details

I. General information

NPI: 1639099823
Provider Name (Legal Business Name): LOGAN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 SAN DIMAS ST STE B
BAKERSFIELD CA
93301-1497
US

IV. Provider business mailing address

2901 SKYLINE BLVD
BAKERSFIELD CA
93305-1863
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-0835
  • Fax: 661-327-0702
Mailing address:
  • Phone: 661-706-4660
  • Fax: 661-327-0702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DR. WADE PHILLIP LOGAN
Title or Position: OWNER/CEO
Credential: LOGAN
Phone: 661-706-4660