Provider Demographics
NPI:1700851524
Name:CHILDERS, LOGAN H JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:H
Last Name:CHILDERS
Suffix:JR
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 1:12600 E 40 HWY
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5955
Mailing Address - Country:US
Mailing Address - Phone:816-478-4202
Mailing Address - Fax:816-478-8920
Practice Address - Street 1:12600 E 40 HWY
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5955
Practice Address - Country:US
Practice Address - Phone:816-478-4202
Practice Address - Fax:816-478-8920
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0106481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry