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Organization
TIMOTHY W. LOGAN, D.M.D., P.S.C.
Active
Organization
TIMOTHY W. LOGAN, D.M.D., P.S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY WILSON LOGAN D.M.D. (OWNER)
(502) 429-0526
Entity
Organization
Contact information
Practice address
9800 SHELBYVILLE RD, SUITE 202, LOUISVILLE, KY 40223-5440
(502) 429-0526
(502) 429-0532
Mailing address
9800 SHELBYVILLE ROAD, SUITE 202, LOUISVILLE, KY 40223-5440
(502) 429-0526
(502) 429-0532
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5015
KY
Other
Enumeration date
04/22/2011
Last updated
04/22/2011
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