| Timothy W. Logan, D.m.d., P.s.c. | |
|
9800 Shelbyville Rd Suite 202 Louisville KY 40223-5440 | |
| (502) 429-0526 | |
| (502) 429-0532 |
| Full Name | Timothy W. Logan, D.m.d., P.s.c. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 9800 Shelbyville Rd, Louisville, Kentucky |
| Authorized Official Name and Position | Timothy Wilson Logan (OWNER) |
| Authorized Official Contact | 5024290526 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Timothy W. Logan, D.m.d., P.s.c. 9800 Shelbyville Road Suite 202 Louisville KY 40223-5440 Ph: (502) 429-0526 | Timothy W. Logan, D.m.d., P.s.c. 9800 Shelbyville Rd Suite 202 Louisville KY 40223-5440 Ph: (502) 429-0526 |
| NPI Number | 1427349687 |
|---|---|
| Provider Enumeration Date | 04/22/2011 |
| Last Update Date | 04/22/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427349687 | NPI | - | NPPES |
| 1548227655 | Other | NPI TYPE 1 | |
| 000000049874 | Other | BLUE CROSS/BLUE SHIEL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 5015 (Kentucky) | Primary |
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