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General NPI Number Information
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NPI Number | 1104131275
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Entity Type | Individual
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Provider Name | LOGAN RAND CURTIS DDS
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Gender | Male
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Dates
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Enumeration Date | 08/13/2010
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Last Update Date | 05/06/2019
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Provider Practice Location Address
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Address Line | 22632 SUMMIT DR STE B
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City | WATERTOWN
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State | NY
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Zip | 13601-7233
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Country | US
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Telephone | 315-405-4005
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Fax |
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Provider Business Mailing Address
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Address Line | 22632 SUMMIT DR STE B
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City | WATERTOWN
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State | NY
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Zip | 13601-7233
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Country | US
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Telephone | 315-405-4005
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7737284-9921
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 058173
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License Number State | NY
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