MEDICARE: LOGAN WEBB DDS

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	122300000X	Dentist	27931	FL

General Provider Information

NPI Number	:	1477238285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOGAN WEBB DDS

Provider Business Mailing Address
First Line	:	1215 S EAST AVE STE 202
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-2353
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 S EAST AVE STE 202
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-2353
Country	:	US
Telephone Number	:	304-687-8188
Fax Number	:

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

Provider Enumeration Date	:	06/19/2023
Last Update Date	:	06/19/2023

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Directions to “ LOGAN WEBB DDS” Practice Location

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