Provider Demographics
NPI:1851088413
Name:FOUTZ, LOGAN B (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:B
Last Name:FOUTZ
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 1:1482 N SKYKOMISH DR
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-0221
Mailing Address - Country:US
Mailing Address - Phone:801-319-5726
Mailing Address - Fax:
Practice Address - Street 1:2344 N MERRITT CREEK LOOP
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4950
Practice Address - Country:US
Practice Address - Phone:208-676-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-55371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice