Provider Demographics
NPI:1346528411
Name:COONER, LOGAN WHITNEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:WHITNEY
Last Name:COONER
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 1:1608 HIGHWAY 78 W
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3668
Mailing Address - Country:US
Mailing Address - Phone:205-221-6218
Mailing Address - Fax:205-221-0998
Practice Address - Street 1:1608 HIGHWAY 78 W
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3668
Practice Address - Country:US
Practice Address - Phone:205-221-6218
Practice Address - Fax:205-221-0998
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-23
Last Update Date:2011-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL58721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice