Provider Demographics
NPI:1508853235
Name:DON LOGUE DDS PC
Entity Type:Organization
Organization Name:DON LOGUE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGUE
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:918-456-3082
Mailing Address - Street 1:1702 PARK HILL RD
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5600
Mailing Address - Country:US
Mailing Address - Phone:918-456-3082
Mailing Address - Fax:918-456-3536
Practice Address - Street 1:1702 PARK HILL RD
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5600
Practice Address - Country:US
Practice Address - Phone:918-456-3082
Practice Address - Fax:918-456-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty