Provider Demographics
NPI:1568905099
Name:LOGAN NALLEY III, D.M.D., P.C.
Entity Type:Organization
Organization Name:LOGAN NALLEY III, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NALLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DR
Authorized Official - Phone:803-716-8434
Mailing Address - Street 1:PO BOX 3189
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13220-3189
Mailing Address - Country:US
Mailing Address - Phone:315-454-6000
Mailing Address - Fax:315-410-5531
Practice Address - Street 1:1961 WHISKEY RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7603
Practice Address - Country:US
Practice Address - Phone:803-716-8434
Practice Address - Fax:803-648-9183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC81901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty