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General NPI Number Information
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NPI Number | 1366266819
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Entity Type | Individual
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Provider Name | LOGAN CHASE CARTER DMD, MS
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Gender | Male
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 6491 JORDAN RD
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City | DAPHNE
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State | AL
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Zip | 36526-4728
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Country | US
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Telephone | 251-625-2525
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 PECAN RDG E
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City | MOBILE
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State | AL
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Zip | 36619-5012
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Country | US
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Telephone | 436-705-4475
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D.007391-C1
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License Number State | AL
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