Provider Demographics
NPI:1780687210
Name:LOGAN, SCOTT ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALLEN
Last Name:LOGAN
Suffix:
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 1:3205 ROBINSON CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-2299
Mailing Address - Country:US
Mailing Address - Phone:936-291-6589
Mailing Address - Fax:936-291-6173
Practice Address - Street 1:3205 ROBINSON CREEK PKWY
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-2299
Practice Address - Country:US
Practice Address - Phone:936-291-6589
Practice Address - Fax:936-291-6173
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-30
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14215332B00000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies