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General NPI Number Information
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NPI Number | 1427365204
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Entity Type | Organization
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Legal Business Name | MICHAEL P. LOGUE, D.M.D., P.A.
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 1800 N FEDERAL HWY SUITE 201
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City | POMPANO BEACH
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State | FL
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Zip | 33062-1034
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Country | US
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Telephone | 954-941-2727
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Fax | 954-941-1116
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Provider Business Mailing Address
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Address Line | 1800 N FEDERAL HWY SUITE 201
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City | POMPANO BEACH
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State | FL
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Zip | 33062-1034
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Country | US
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Telephone | 954-941-2727
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Fax | 954-941-1116
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Authorized Official
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Title or Position | PRESIDENT/ORAL SURGEON
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Name | DR. MICHAEL P LOGUE
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Credential | D.M.D.
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Telephone | 954-941-2727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | DN12346
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License Number State | FL
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