Individual
DR. MICHAEL GREGORY LOGELIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
BLDG 45005 RUNION DENTAL CLINIC, USA DENTAC, FT HUACHUCA, AZ 85670
(520) 533-3144
(520) 533-7285
Mailing address
3757 CAMINO BELLA ROSA, SIERRA VISTA, AZ 85650-9410
(702) 326-8519
(520) 378-9982
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
28353
CA
1223G0001X
General Practice Dentistry
Primary
3481
NV
1223G0001X
General Practice Dentistry
9858
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002202771
—
NV
05
—
32170513
—
CO
05
—
D28353
—
CA
Enumeration date
07/19/2006
Last updated
11/27/2012
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