Organization
NORTH LOGAN PDC PLLC
Active
Other names
Platinum Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB WARNER (CREDENTIALING MANAGER)
(801) 691-1701
Entity
Organization
Contact information
Practice address
1445 N 400 E STE 3A, LOGAN, UT 84341-7564
(435) 752-1699
Mailing address
PO BOX 970184, OREM, UT 84097-0309
(901) 305-3460
(801) 335-6551
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223P0300X
Periodontics
—
—
Other
Enumeration date
05/29/2019
Last updated
05/29/2019
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