Healthcare Provider Details

I. General information

NPI: 1992598882
Provider Name (Legal Business Name): LOGAN WOLF SCHWEITZER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 TRUEMPER ST
JBSA LACKLAND TX
78236-5511
US

IV. Provider business mailing address

1615 TRUEMPER ST
JBSA LACKLAND TX
78236-5511
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-0123
  • Fax:
Mailing address:
  • Phone: 210-292-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14226370-9926
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14226370-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: