Individual
MR. LOGAN WAYNE COFFEE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
HIGHWAY 83 SOUTH AND I-40 JUNCTION, VIAN, OK 74962
(918) 773-6200
(918) 773-6201
Mailing address
PO BOX 412, VIAN, OK 74962-0412
(918) 773-6200
(918) 773-6201
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5317
OK
Other
Enumeration date
06/14/2006
Last updated
07/08/2007
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