Provider Demographics
NPI:1104131275
Name:CURTIS, LOGAN RAND (DDS)
Entity type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:RAND
Last Name:CURTIS
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 1:22632 SUMMIT DR STE B
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-7233
Mailing Address - Country:US
Mailing Address - Phone:315-405-4005
Mailing Address - Fax:
Practice Address - Street 1:22632 SUMMIT DR STE B
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-7233
Practice Address - Country:US
Practice Address - Phone:315-405-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7737284-9921122300000X
NY0581731223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist