Provider Demographics
NPI:1942869227
Name:SCOTT A. LOGAN, DDS, PA
Entity Type:Organization
Organization Name:SCOTT A. LOGAN, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:936-291-6589
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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOTT A. LOGAN, DDS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies