Provider Demographics
NPI:1518023894
Name:LOGAN, JAMES L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:LOGAN
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 1:29632 HIGHWAY 299 EAST.
Mailing Address - Street 2:
Mailing Address - City:ROUND MOUNTAIN
Mailing Address - State:CA
Mailing Address - Zip Code:96084-0228
Mailing Address - Country:US
Mailing Address - Phone:530-337-6244
Mailing Address - Fax:530-337-5791
Practice Address - Street 1:29632 HIGHWAY 299 EAST
Practice Address - Street 2:
Practice Address - City:ROUND MOUNTAIN
Practice Address - State:CA
Practice Address - Zip Code:96084-0228
Practice Address - Country:US
Practice Address - Phone:530-337-6244
Practice Address - Fax:530-337-5791
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS25169122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist