| Lee R. Logan, D.d.s., Prof. Corp. | |
|
18250 Roscoe Blvd Suite #315 Northridge CA 91325-4226 | |
| (818) 885-8650 | |
| (818) 885-7169 |
| Full Name | Lee R. Logan, D.d.s., Prof. Corp. |
|---|---|
| Speciality | Dentist |
| Location | 18250 Roscoe Blvd, Northridge, California |
| Authorized Official Name and Position | Lee Robert Logan (PRESIDENT) |
| Authorized Official Contact | 8188858650 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lee R. Logan, D.d.s., Prof. Corp. 18250 Roscoe Blvd Suite #315 Northridge CA 91325-4226 Ph: (818) 885-8650 | Lee R. Logan, D.d.s., Prof. Corp. 18250 Roscoe Blvd Suite #315 Northridge CA 91325-4226 Ph: (818) 885-8650 |
| NPI Number | 1003869769 |
|---|---|
| Provider Enumeration Date | 05/17/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003869769 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 13848 (California) | Primary |
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