Provider Demographics
NPI:1679180046
Name:LOGAN P GOULET DMD PLLC
Entity Type:Organization
Organization Name:LOGAN P GOULET DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOULET
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-671-2617
Mailing Address - Street 1:3150 E 27TH AVE # 200
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4919
Mailing Address - Country:US
Mailing Address - Phone:509-838-4141
Mailing Address - Fax:
Practice Address - Street 1:3150 E 27TH AVE # 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4919
Practice Address - Country:US
Practice Address - Phone:509-838-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental