Provider Demographics
NPI:1134816374
Name:NORENE, LOGAN (DMD)
Entity type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:
Last Name:NORENE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10552 N CANTERBURY WAY
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9243
Mailing Address - Country:US
Mailing Address - Phone:530-933-9686
Mailing Address - Fax:
Practice Address - Street 1:1834 S STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-8109
Practice Address - Country:US
Practice Address - Phone:801-899-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8932312-9923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist