MEDICARE: SCOTT A. LOGAN, DDS, PA

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1942869227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT A. LOGAN, DDS, PA

Provider Business Mailing Address
First Line	:	3205 ROBINSON CREEK PKWY
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340-2299
Country	:	US
Telephone Number	:	936-291-6589
Fax Number	:	936-291-6173

Provider Business Practice Location Address
First Line	:	3205 ROBINSON CREEK PKWY
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340-2299
Country	:	US
Telephone Number	:	936-291-6589
Fax Number	:	936-291-6173

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SCOTT ALLEN LOGAN
Credential	:	DDS
Telephone Number	:	936-291-6589

Provider Enumeration Date	:	06/10/2019
Last Update Date	:	06/10/2019

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