Provider Demographics
NPI:1497435689
Name:LASSIN, LOGAN ELI (DMD)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:ELI
Last Name:LASSIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 KINGS HWY N
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2306
Mailing Address - Country:US
Mailing Address - Phone:856-795-8080
Mailing Address - Fax:856-795-6276
Practice Address - Street 1:1401 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2306
Practice Address - Country:US
Practice Address - Phone:856-795-8080
Practice Address - Fax:856-795-6276
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI029808001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice