Polly Jo Courtney Logan DDS

NPI 1043221153 - Dentist - 122300000X

NPI Details
NPI 1043221153
Gender Female
Enumeration Date 08/11/2006
Last Updated 07/08/2007
Entity Type Individual
Active Over 10 years ago
Practice Location
13961 60TH ST
ST CROIX VALLEY DENTAL
STILLWATER MN, 55082, US
Phone (651) 439-2600
Fax (651) 439-2211
Business Location
PO BOX 291
ST CROIX VALLEY DENTAL PLLC
STILLWATER MN, 55082, US
Phone (651) 439-2600
Fax (651) 439-2211
Toxanomy
Taxonomy Code 122300000X
License State Wisconsin
License Number 5740015
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According to our database, Dr. Polly Jo Courtney Logan DDS NPI is 1043221153, taxonomy code is 122300000X and license number is 5740015, license state is located at Wisconsin. Polly Jo Courtney Logan DDS physically located at 13961 60th St, Stillwater MN, 55082. NPI Number Polly Jo Courtney Logan DDS has the Individual type.

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1043221153 NPI number is provided on an as is basis without warranty of any kind. 1043221153 is maintained by the National Plan & Provider Enumeration System. The contents of Polly Jo Courtney Logan DDS are for informational purposes only.