NPIMap

Organization Active NPI

Lee R. Logan, D.D.S., Prof. Corp.

  • Dentist
  • Northridge, CA
National Provider Identifier
1003869769
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
13848 Issued in CA
Legal business name
LEE R. LOGAN, D.D.S., PROF. CORP.
Practice address
18250 Roscoe Blvd
Suite #315
Northridge, CA 91325-4226
Phone
(818) 885-8650
Fax
(818) 885-7169
NPI assigned
May 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Lee Robert Logan, D.D.S.,M.S.
Title
President
Phone
(818) 885-8650

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 13848 CA Primary

Addresses

Primary practice location

18250 Roscoe Blvd
Suite #315
Northridge, CA 91325-4226

Mailing address

18250 Roscoe Blvd
Suite #315
Northridge, CA 91325-4226
Phone (818) 885-8650

National Provider Directory

National Provider Directory

Locations

18250 Roscoe Blvd
Ste 315
Northridge, CA 91325
Phone (818) 885-8650

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003869769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18250 ROSCOE BLVD",
            "address_2": "SUITE #315",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913254226",
            "telephone_number": "818-885-8650",
            "fax_number": "818-885-7169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18250 ROSCOE BLVD",
            "address_2": "SUITE #315",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913254226",
            "telephone_number": "818-885-8650",
            "fax_number": "818-885-7169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEE R. LOGAN, D.D.S., PROF. CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-885-8650",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S.,M.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "13848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northridge, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.