Provider Demographics
NPI:1194336420
Name:MONIGHAN, LOGAN (DENTIST)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:MONIGHAN
Suffix:
Gender:F
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 GIBRALTAR RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-9460
Mailing Address - Country:US
Mailing Address - Phone:610-370-5955
Mailing Address - Fax:610-370-5957
Practice Address - Street 1:90 GIBRALTAR RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-9460
Practice Address - Country:US
Practice Address - Phone:610-370-5955
Practice Address - Fax:610-370-5957
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0428291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice