Provider Demographics
NPI:1922111335
Name:LOGMANN, MATTHEW BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRUCE
Last Name:LOGMANN
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 1:7141 INDIANAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-2220
Mailing Address - Country:US
Mailing Address - Phone:219-844-3635
Mailing Address - Fax:219-845-2625
Practice Address - Street 1:7141 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-2220
Practice Address - Country:US
Practice Address - Phone:219-844-3635
Practice Address - Fax:219-845-2625
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007813A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice