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General NPI Number Information
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NPI Number | 1851933287
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Entity Type | Individual
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Provider Name | JERI A. LOGAN DDS
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Gender | Female
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Dates
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Enumeration Date | 10/17/2019
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Last Update Date | 10/17/2019
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Provider Practice Location Address
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Address Line | 8064 W JEWELL AVE UNIT 100
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City | LAKEWOOD
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State | CO
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Zip | 80232-6710
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Country | US
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Telephone | 303-985-3624
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Fax |
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Provider Business Mailing Address
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Address Line | 2024 S UTICA ST
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City | DENVER
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State | CO
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Zip | 80219-5031
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Country | US
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Telephone | 303-748-2971
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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 | DEN.00204091
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License Number State | CO
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