Provider Demographics
NPI:1518045590
Name:LOGAN, BERNARD THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:THOMAS
Last Name:LOGAN
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 1:730 PARKWOOD DR
Mailing Address - Street 2:SUITE 75
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6312
Mailing Address - Country:US
Mailing Address - Phone:724-776-2177
Mailing Address - Fax:724-776-2178
Practice Address - Street 1:730 PARKWOOD DR
Practice Address - Street 2:SUITE 75
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6312
Practice Address - Country:US
Practice Address - Phone:724-776-2177
Practice Address - Fax:724-776-2178
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020674L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice