Robert Dictrow DDS, Bruce S. Logue DDS, PC

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

029219 Issued in NY

Legal business name

ROBERT DICTROW DDS, BRUCE S. LOGUE DDS, PC

Practice address

652 Suffolk Avenue
Brentwood, NY 11717

Phone

(631) 273-0988

Fax

(631) 273-0949

NPI assigned

May 3, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Bruce S. Logue, D.D.S.

Title

VP

Phone

(631) 273-0988

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225240385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "652 SUFFOLK AVENUE",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "11717",
            "telephone_number": "631-273-0988",
            "fax_number": "631-273-0949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "652 SUFFOLK AVENUE",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "11717",
            "telephone_number": "631-273-0988",
            "fax_number": "631-273-0949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT DICTROW DDS, BRUCE S. LOGUE DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LOGUE",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "631-273-0988",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "NY",
            "license": "029219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Endodontics in Brentwood, NY
• Providers in Brentwood, NY by specialty
• Endodontics in New York

• 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.