# DR. LOGAN COLLINS BANNER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1740577592
- **Gender:** Man
- **Credential:** D.D.S.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DE60226297 | WA | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 32707 | TX | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 7046 | LA | Yes |

## Other

- **Enumeration date:** 06/30/2011
- **Last updated:** 07/28/2024