Ronald William Logan Jr., D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5824 Issued in NC

Practice address

4622 Country Club Rd
Suite 240
Winston Salem, NC 27104

Phone

(336) 760-9400

Fax

(336) 760-0963

NPI assigned

May 9, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487868378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4622 COUNTRY CLUB RD",
            "address_2": "SUITE 240",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27104",
            "telephone_number": "336-760-9400",
            "fax_number": "336-760-0963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4622 COUNTRY CLUB RD",
            "address_2": "SUITE 240",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27104",
            "telephone_number": "336-760-9400",
            "fax_number": "336-760-0963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "RONALD",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "5824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grace Catherine Loeffler, PA-C
• Kathryn Alice Lofland, FNP
• Jennifer Davis Loflin
• Mary Anne Loftin, LPT, ATP
• Lee Loftis, PHARM.D.
• Nicole Marie Logie, FNP-BC, WHNP-BC
• Chee Hong Loh, MD
• Caroline Loher
• Amy Leigh Loken, PHARMD, BCPS
• Anitha Lokesh, M.D.

• General Practice Dentistry in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.