Individual
DR. BRADLEY DWIGHT LOGIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2776 RINGGOLD ROAD, ATTN: CREDENTIALS COORDINATOR, FORT SILL, OK 73503-6300
(580) 442-3905
(580) 442-4002
Mailing address
PO BOX 268819, OKLAHOMA CITY, OK 73126-8819
(269) 556-9398
(269) 556-9488
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
L117008
MI
Other
Enumeration date
08/28/2007
Last updated
01/07/2019
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