# ORAL AND MAXILLOFACIAL SURGERY

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

## Provider details

- **NPI number:** 1588986525
- **Authorized official:** BRUCE S LOGAN DDS (OWNER)
- **Authorized official phone:** (541) 779-7799

## Contact information

- **Practice address:** 3162 STATE ST, MEDFORD, OR 97504-8450
- **Practice address phone:** (541) 779-7799
- **Practice address fax:** (541) 779-7805
- **Mailing address:** 3162 STATE ST, MEDFORD, OR 97504-8450
- **Mailing address phone:** (541) 779-7799
- **Mailing address fax:** (541) 779-7805

## Taxonomy

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

## Other

- **Enumeration date:** 02/18/2010
- **Last updated:** 07/17/2020