Healthcare Provider Details

I. General information

NPI: 1851226781
Provider Name (Legal Business Name): LOGAN JARED NEWMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CLEARVIEW RD
MADISON HEIGHTS VA
24572-2600
US

IV. Provider business mailing address

205 KEELY LN
SCHWENKSVILLE PA
19473-2837
US

V. Phone/Fax

Practice location:
  • Phone: 434-929-1400
  • Fax: 434-929-0410
Mailing address:
  • Phone: 434-929-1400
  • Fax: 434-929-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401420107
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: