Healthcare Provider Details

I. General information

NPI: 1124021068
Provider Name (Legal Business Name): DANIEL G LOGGI JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 ROOSEVELT BLVD
MARMORA NJ
08223-1402
US

IV. Provider business mailing address

PO BOX 898
CAPE MAY COURT HOUSE NJ
08210-0898
US

V. Phone/Fax

Practice location:
  • Phone: 609-390-0331
  • Fax: 609-390-2602
Mailing address:
  • Phone: 609-465-4340
  • Fax: 609-465-5064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDI016516
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: