Logan William Smith, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2023021391 Issued in MO

Practice address

3009 Highway K
O Fallon, MO 63368-8696

Phone

(636) 379-7552

NPI assigned

Jul 13, 2023

Last updated

Jul 13, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 MO

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Alex Sharifian DDS Ofallon Modern Dentistry PC

  dba O'Fallon Modern Dentistry

  • General Practice Dentistry
  • O'Fallon, MO
  • NPI 1407281314
  NPD (past)

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

{
    "created_epoch": "1689206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689206400000",
    "number": "1831878214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "932 MILLWOOD DR",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633767029",
            "telephone_number": "636-293-8250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3009 HIGHWAY K",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633688696",
            "telephone_number": "636-379-7552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "LOGAN",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-07-13",
        "last_updated": "2023-07-13",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2023021391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abbey Lynn Smith, D.M.D.
• Aimee Elizabeth Smith, PT
• Janice Marie Smith, MA, BCBA
• Kelli Simone Smith, DMD
• Lillie L Smith
• Rachel Hoesli Smith, APRN
• Rebecca J. Smith, PA-C
• Teresa M Smith, NP
• Julie Snider
• Snoscar, Inc. (Family Eyewear Gallery)

• General Practice Dentistry in O'Fallon, MO
• Providers in O'Fallon, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2023; 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.