Provider Demographics
NPI:1487868378
Name:LOGAN, RONALD WILLIAM JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WILLIAM
Last Name:LOGAN
Suffix:JR
Gender:M
Credentials:DDS
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Mailing Address - Street 1:4622 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104
Mailing Address - Country:US
Mailing Address - Phone:336-760-9400
Mailing Address - Fax:336-760-0963
Practice Address - Street 1:4622 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 240
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104
Practice Address - Country:US
Practice Address - Phone:336-760-9400
Practice Address - Fax:336-760-0963
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC58241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice