Healthcare Provider Details

I. General information

NPI: 1891441697
Provider Name (Legal Business Name): LOGAN KLUDT LAWRENCE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6902 PINE ST
OMAHA NE
68106-2855
US

IV. Provider business mailing address

4000 E CAMPUS LOOP S
LINCOLN NE
68583-1530
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-6418
  • Fax:
Mailing address:
  • Phone: 402-472-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8194
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD14715
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: