Provider Demographics
NPI:1093079147
Name:LOGAN, CLAIRE STANFORD (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:STANFORD
Last Name:LOGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ERIN
Other - Middle Name:CLAIRE
Other - Last Name:STANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4761 ANDREW JACKSON PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1354
Mailing Address - Country:US
Mailing Address - Phone:615-885-3525
Mailing Address - Fax:615-885-9767
Practice Address - Street 1:4761 ANDREW JACKSON PKWY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1354
Practice Address - Country:US
Practice Address - Phone:615-885-3525
Practice Address - Fax:615-885-9767
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist