Provider Demographics
NPI:1588794168
Name:MATTHEW B. LOGMANN DDS, PC
Entity type:Organization
Organization Name:MATTHEW B. LOGMANN DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:LOGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-844-3635
Mailing Address - Street 1:7141 INDIANAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-2220
Mailing Address - Country:US
Mailing Address - Phone:219-844-3635
Mailing Address - Fax:219-845-2625
Practice Address - Street 1:7141 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-2220
Practice Address - Country:US
Practice Address - Phone:219-844-3635
Practice Address - Fax:219-845-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007813A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty