Organization
LOGANSMILES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT LAKE THEURER DMD (MANAGER, OWNER DENTIST)
(435) 752-2230
Entity
Organization
Contact information
Practice address
1340 N 600 E STE 1, LOGAN, UT 84341-2475
(435) 752-2230
(435) 752-6481
Mailing address
1340 N 600 E STE 1, LOGAN, UT 84341-2475
(435) 752-2230
(435) 752-6481
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/17/2019
Last updated
01/17/2019
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