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General NPI Number Information
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NPI Number | 1255499570
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Entity Type | Individual
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Provider Name | JESSICA LEE LOGAN D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11 KIEL AVE
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City | KINNELON
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State | NJ
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Zip | 07405-2549
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Country | US
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Telephone | 973-838-4460
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Fax | 973-838-6258
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Provider Business Mailing Address
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Address Line | 911 CASTLE POINT TER APT. #2
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City | HOBOKEN
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State | NJ
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Zip | 07030-5908
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Country | US
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Telephone | 201-618-0623
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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 | DI02262300
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License Number State | NJ
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