MEDICARE: DR. LOGAN WOOD D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	23937	TX

General Provider Information

NPI Number	:	1386808699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOGAN WOOD D.D.S.

Provider Business Mailing Address
First Line	:	1362 WILSON RD
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304
Country	:	US
Telephone Number	:	936-539-2211
Fax Number	:	936-539-2862

Provider Business Practice Location Address
First Line	:	1362 WILSON RD
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304
Country	:	US
Telephone Number	:	936-539-2211
Fax Number	:	936-539-2862

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	10/02/2020

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Directions to “ DR. LOGAN WOOD D.D.S.” Practice Location

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