Provider Demographics
NPI:1467216960
Name:MCCORD, LOGAN SHAYNE (DMD)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:SHAYNE
Last Name:MCCORD
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 1:7998 SHADY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:GRAND RIDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32442-3814
Mailing Address - Country:US
Mailing Address - Phone:850-544-1993
Mailing Address - Fax:
Practice Address - Street 1:7998 SHADY GROVE RD
Practice Address - Street 2:
Practice Address - City:GRAND RIDGE
Practice Address - State:FL
Practice Address - Zip Code:32442-3814
Practice Address - Country:US
Practice Address - Phone:850-544-1993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program