Provider Demographics
NPI:1316266059
Name:BELL, LOGAN T (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:T
Last Name:BELL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 HILLGROVE AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1417
Mailing Address - Country:US
Mailing Address - Phone:708-784-9930
Mailing Address - Fax:708-784-9931
Practice Address - Street 1:518 HILLGROVE AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1417
Practice Address - Country:US
Practice Address - Phone:708-784-9930
Practice Address - Fax:708-784-9931
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028254122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist