Individual
DR. LOGAN ICENHOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1516 DOCTORS CIR, WILMINGTON, NC 28401-7404
(910) 251-1100
Mailing address
1516 DOCTORS CIR, WILMINGTON, NC 28401-7404
(910) 251-1100
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
0006706
AL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
12611
NC
Other
Enumeration date
10/01/2019
Last updated
08/23/2022
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