Provider Demographics
NPI:1265529226
Name:LOGAN, CORY JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:CORY
Middle Name:JAMES
Last Name:LOGAN
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 1:6633 TELUCO ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-5359
Mailing Address - Country:US
Mailing Address - Phone:713-290-0331
Mailing Address - Fax:
Practice Address - Street 1:530 WAUGH DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-2002
Practice Address - Country:US
Practice Address - Phone:713-942-8598
Practice Address - Fax:713-942-8591
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice