Individual
DR. LOGAN CHARLES GOODRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1234 E DUPONT RD STE 4, FORT WAYNE, IN 46825-1545
(260) 490-3495
Mailing address
8429 HUNTERS KNOLL RUN, FORT WAYNE, IN 46825-6406
(260) 515-8864
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12013386A
IN
Other
Enumeration date
06/19/2020
Last updated
06/19/2020
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