Provider Demographics
NPI:1437848066
Name:CLAIRE LOGAN, DDS, PLLC
Entity Type:Organization
Organization Name:CLAIRE LOGAN, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-936-2526
Mailing Address - Street 1:996 TOP ST
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9541
Mailing Address - Country:US
Mailing Address - Phone:601-936-2526
Mailing Address - Fax:601-936-2426
Practice Address - Street 1:996 TOP ST
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9541
Practice Address - Country:US
Practice Address - Phone:601-936-2526
Practice Address - Fax:601-936-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1972662203Medicaid
MS1912112061Medicaid
TN1093079147Medicaid