Healthcare Provider Details

I. General information

NPI: 1124657382
Provider Name (Legal Business Name): LOGAN MICHAEL DILIK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26179 DETROIT RD
WESTLAKE OH
44145-2430
US

IV. Provider business mailing address

184 MOOREWOOD AVE
AVON LAKE OH
44012-1418
US

V. Phone/Fax

Practice location:
  • Phone: 440-583-6677
  • Fax:
Mailing address:
  • Phone: 440-714-2479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number30.026104
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: