Provider Demographics
NPI:1104207968
Name:BARNES, LOGAN DAVID (DMD)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:DAVID
Last Name:BARNES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11990 HIGHWAY 17 BY-PASS
Mailing Address - Street 2:UNIT 8
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29756
Mailing Address - Country:US
Mailing Address - Phone:843-651-0314
Mailing Address - Fax:843-651-3662
Practice Address - Street 1:11990 HIGHWAY 17 BY-PASS
Practice Address - Street 2:UNIT 8
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29756
Practice Address - Country:US
Practice Address - Phone:843-651-0314
Practice Address - Fax:843-651-3662
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice