Provider Demographics
NPI:1821160953
Name:LOGAN, BERNADETTE ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:ANNE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1116
Mailing Address - Country:US
Mailing Address - Phone:610-408-0997
Mailing Address - Fax:
Practice Address - Street 1:72 PAOLI PIKE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1831
Practice Address - Country:US
Practice Address - Phone:610-647-1666
Practice Address - Fax:610-889-7547
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028916L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice