North Logan Pdc Pllc

NPI #1649837337 in Logan, Utah

Provider Information

NPI Number: 1649837337
Entity Type: Organization
Organization Name: North Logan Pdc Pllc
Primary Specialty: Dentist
Enumeration Date: May 29, 2019
Last Updated: May 29, 2019

Practice Location

Address: 1445 N 400 E STE 3A
City: Logan
State: Utah
ZIP Code: 84341-7564
Phone: (435) 752-1699

Authorized Official

Name: JACOB WARNER
Title: CREDENTIALING MANAGER
Phone: (801) 691-1701

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Periodontics — Periodontics	1223P0300X
Dentist	122300000X	Primary

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