Healthcare Provider Details

I. General information

NPI: 1770407728
Provider Name (Legal Business Name): LOGAN CECIL RDHAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 W EAST AVE
CHICO CA
95926-2002
US

IV. Provider business mailing address

845 W EAST AVE
CHICO CA
95926-2002
US

V. Phone/Fax

Practice location:
  • Phone: 530-896-9400
  • Fax:
Mailing address:
  • Phone: 530-896-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHAP961
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number27550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: