Provider Demographics
NPI:1497282321
Name:VANHOOF, LOGAN TAYLOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:TAYLOR
Last Name:VANHOOF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 W COLLEGE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-5291
Mailing Address - Country:US
Mailing Address - Phone:920-739-4246
Mailing Address - Fax:
Practice Address - Street 1:1033 W COLLEGE AVE STE 200
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-5291
Practice Address - Country:US
Practice Address - Phone:920-739-4246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001565-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist