Individual
LOGAN CORNWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1025 S POWER RD STE 106, MESA, AZ 85206-5240
(480) 386-9111
Mailing address
1025 S POWER RD STE 106, MESA, AZ 85206-5240
(480) 386-9111
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D010936
AZ
1223G0001X
General Practice Dentistry
DEN.00204475
CO
Other
Enumeration date
05/19/2020
Last updated
04/09/2024
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