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General NPI Number Information
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NPI Number | 1871179903
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Entity Type | Individual
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Provider Name | LOGAN ALAN HERM DDS
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Gender | Male
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Dates
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Enumeration Date | 03/19/2021
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 105 CYPRESS POINT PKWY STE B
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City | PALM COAST
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State | FL
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Zip | 32164-8490
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Country | US
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Telephone | 386-445-0555
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Fax |
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Provider Business Mailing Address
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Address Line | 200 ALBERT SABIN WAY OFC 2220
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City | CINCINNATI
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State | OH
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Zip | 45267-2800
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Country | US
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Telephone | 513-584-2586
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Fax | 513-584-1125
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN26678
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License Number State | FL
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