Individual
TIMOTHY W LOGAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
9800 SHELBYVILLE RD, SUITE 202, LOUISVILLE, KY 40223-2977
(502) 429-0526
(502) 429-0532
Mailing address
9800 SHELBYVILLE RD, SUITE 202, LOUISVILLE, KY 40223-2977
(502) 429-0526
(502) 429-0532
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
12010128A
IN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5015
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000049874
BLUE CROSS BLUE SHIELD
—
Enumeration date
05/01/2006
Last updated
07/08/2007
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