Individual
LOGAN WEDDING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
309 E MARKET ST UNIT 311, LOUISVILLE, KY 40202-1274
(270) 831-0967
Mailing address
309 E MARKET ST UNIT 311, LOUISVILLE, KY 40202-1274
(270) 831-0967
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
10583
KY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
12013606A
IN
Other
Enumeration date
06/21/2021
Last updated
06/21/2021
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