Provider Demographics
NPI:1851933287
Name:LOGAN, JERI A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERI
Middle Name:A
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 1:2024 S UTICA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-5031
Mailing Address - Country:US
Mailing Address - Phone:303-748-2971
Mailing Address - Fax:
Practice Address - Street 1:8064 W JEWELL AVE UNIT 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-6710
Practice Address - Country:US
Practice Address - Phone:303-985-3624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00204091122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist