Logan, Theodore E

Logan, Theodore E is an individual health care provider with primary practice located at 3101 Breckenridge Ln Ste 2D, Louisville KY 40220-2742. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Logan, Theodore E can be contacted via phone (502) 459-8012.

Contact Information

Primary practice address
3101 Breckenridge Ln Ste 2D Louisville KY 40220-2742
Phone: (502) 459-8012
Fax: (502) 459-8021
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 4056 Kentucky

Profile Details

NPI number 1245231778
LBN Legal business name Logan, Theodore E
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 9th, 2005
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245231778 NPPES
Kentucky MEDICAID 64040561
Kentucky Other 1055007
Kentucky Other 60040565

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