# TIMOTHY W. LOGAN, D.M.D., P.S.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427349687
- **Authorized official:** DR. TIMOTHY WILSON LOGAN D.M.D. (OWNER)
- **Authorized official phone:** (502) 429-0526

## Contact information

- **Practice address:** 9800 SHELBYVILLE RD, SUITE 202, LOUISVILLE, KY 40223-5440
- **Practice address phone:** (502) 429-0526
- **Practice address fax:** (502) 429-0532
- **Mailing address:** 9800 SHELBYVILLE ROAD, SUITE 202, LOUISVILLE, KY 40223-5440
- **Mailing address phone:** (502) 429-0526
- **Mailing address fax:** (502) 429-0532

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 5015 | KY | Yes |

## Other

- **Enumeration date:** 04/22/2011
- **Last updated:** 04/22/2011