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General NPI Number Information
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NPI Number | 1851448229
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Entity Type | Organization
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Legal Business Name | EDWARD M. LOGAN, DDS, LC
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9016 PHOENIX PKWY
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City | O FALLON
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State | MO
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Zip | 63368-4278
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Country | US
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Telephone | 636-561-5445
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Fax |
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Provider Business Mailing Address
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Address Line | 7 MATTERHORN CT
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City | O FALLON
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State | MO
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Zip | 63366-4804
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Country | US
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Telephone | 314-302-7100
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EDWARD M. LOGAN
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Credential | DDS
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Telephone | 636-561-5445
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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 | 2002002458
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License Number State | MO
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