Healthcare Provider Details

I. General information

NPI: 1871179903
Provider Name (Legal Business Name): LOGAN ALAN HERM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CYPRESS POINT PKWY STE B
PALM COAST FL
32164-8490
US

IV. Provider business mailing address

200 ALBERT SABIN WAY OFC 2220
CINCINNATI OH
45267-2800
US

V. Phone/Fax

Practice location:
  • Phone: 386-445-0555
  • Fax:
Mailing address:
  • Phone: 513-584-2586
  • Fax: 513-584-1125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN26678
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: