THEODORE E LOGAN DMD NPI 1245231778

NPI Information

NPI: 1245231778
Provider Name: THEODORE E LOGAN, DMD
Classification: Dentist - 1223S0112X
Entity Type: Individual

Specialization: Oral and Maxillofacial Surgery

Address:
3101 BRECKENRIDGE LN
STE 2D
LOUISVILLE, KY
ZIP 40220
Phone: (502) 459-8012
Get Directions

Theodore E Logan, DMD is an oral and maxillofacial surgery dentist in Louisville, KY. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. Theodore E Logan, DMD NPI is 1245231778. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3101 BRECKENRIDGE LN
STE 2D
LOUISVILLE, KY
ZIP 40220-742
Phone: (502) 459-8012
Fax: (502) 459-8021

The enumeration date for this NPI number is 8/9/2005 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223S0112X	Dentist	Oral and Maxillofacial Surgery	4056	KENTUCKY	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0269502	MEDICARE ID-TYPE UNSPECIFIED	KENTUCKY
2	1055007	OTHER	KENTUCKY	PASSPORT
3	60040565	OTHER	KENTUCKY	MEDICAID DENTAL
4	64040561	MEDICAID	KENTUCKY
5	U09220	MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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