Healthcare Provider Details

I. General information

NPI: 1073435632
Provider Name (Legal Business Name): LOGAN NEIL MORRISON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 N HAPPY VALLEY RD STE 120
NAMPA ID
83687-5781
US

IV. Provider business mailing address

1255 N HAPPY VALLEY RD STE 120
NAMPA ID
83687-5781
US

V. Phone/Fax

Practice location:
  • Phone: 208-563-2724
  • Fax:
Mailing address:
  • Phone: 208-563-2724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4081727
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: