Individual
EDWARD M. LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
9016 PHOENIX PKWY, O FALLON, MO 63368-4278
(636) 561-5445
Mailing address
7 MATTERHORN CT, O FALLON, MO 63366-4804
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2002002458
MO
Other
Enumeration date
07/08/2007
Last updated
07/08/2007
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