Provider Demographics
NPI:1801052543
Name:STANLEY, LOGAN HYATT (DDS)
Entity type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:HYATT
Last Name:STANLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:LOGAN
Other - Middle Name:HYATT
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:800 ESPERANZA AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654
Mailing Address - Country:US
Mailing Address - Phone:830-693-0748
Mailing Address - Fax:
Practice Address - Street 1:800 ESPERANZA AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654
Practice Address - Country:US
Practice Address - Phone:830-693-0748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX240041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice