Individual
DR. MARK P LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
123 DWIGHT RD, LONGMEADOW, MA 01106-1748
(413) 567-0341
(413) 567-7299
Mailing address
123 DWIGHT RD, LONGMEADOW, MA 01106-1748
(413) 567-0341
(413) 567-7299
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
1550
MA
Other
Enumeration date
06/16/2006
Last updated
07/08/2007
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