Individual
DR. LOGAN COLLINS BANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2120 BERT KOUNS INDUSTRIAL LOOP STE D, SHREVEPORT, LA 71118-3351
(318) 687-9800
Mailing address
5718 MARINA BAY DR, SHREVEPORT, LA 71119-3918
(206) 718-3063
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DE60226297
WA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
32707
TX
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7046
LA
Other
Enumeration date
06/30/2011
Last updated
07/28/2024
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