Provider Demographics
NPI:1659596955
Name:MAY, LOGAN V (LD)
Entity Type:Individual
Prefix:MR
First Name:LOGAN
Middle Name:V
Last Name:MAY
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16111 SE MCGILLIVRAY BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9033
Mailing Address - Country:US
Mailing Address - Phone:360-931-8552
Mailing Address - Fax:
Practice Address - Street 1:16111 SE MCGILLIVRAY BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9033
Practice Address - Country:US
Practice Address - Phone:360-931-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000457122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist