Provider Demographics
NPI:1003424342
Name:LOGAN B HALL, DDS PLLC
Entity Type:Organization
Organization Name:LOGAN B HALL, DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING DENTAL PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-751-4609
Mailing Address - Street 1:712 W MEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4462
Mailing Address - Country:US
Mailing Address - Phone:479-751-4609
Mailing Address - Fax:479-751-6519
Practice Address - Street 1:712 W MEADOW AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4462
Practice Address - Country:US
Practice Address - Phone:479-751-4609
Practice Address - Fax:479-751-6519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4177OtherDENTAL INSURANCE