Healthcare Provider Details

I. General information

NPI: 1023502671
Provider Name (Legal Business Name): LOGAN PATRICK CASH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 04/23/2022
Certification Date: 04/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 FACULTY DR # B
USAF ACADEMY CO
80840-1805
US

IV. Provider business mailing address

10009 GLEN MEADOW RD
LOUISVILLE KY
40241-1195
US

V. Phone/Fax

Practice location:
  • Phone: 719-333-5192
  • Fax:
Mailing address:
  • Phone: 502-330-8326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10139
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: