Provider Demographics
NPI:1407348485
Name:SCHUITEMAN, LOGAN BREANN (DMD)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:BREANN
Last Name:SCHUITEMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 MABRY HOOD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-2669
Mailing Address - Country:US
Mailing Address - Phone:865-675-3773
Mailing Address - Fax:
Practice Address - Street 1:614 MABRY HOOD RD STE 201
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-2669
Practice Address - Country:US
Practice Address - Phone:865-675-3773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022636122300000X
WI1002187-151223G0001X
TN120791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist