Edward M. Logan, DDS Valid NPI
Individual provider · Dentist · O Fallon, MO
- NPI
- 1669670980
- Type
- Individual (Type 1)
- Primary specialty
- Dentist
- Specialty group
- Dental Providers
- Taxonomy code
- 122300000X
- License number
- 2002002458 (MO)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2007-07-08
- Last updated
- 2007-07-08
Practice location
9016 Phoenix Pkwy
O Fallon, MO 63368-4278
(636) 561-5445