NPIMap

Organization Active NPI

Edward M. Logan, DDS, LC

  • Dentist
  • O'Fallon, MO
National Provider Identifier
1851448229
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2002002458 Issued in MO
Legal business name
EDWARD M. LOGAN, DDS, LC
Practice address
9016 Phoenix Pkwy
O Fallon, MO 63368-4278
Phone
(636) 561-5445
NPI assigned
Jan 5, 2007
Last updated
Aug 22, 2020By the provider in NPPES
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
Edward M. Logan, DDSNPI 1669670980
Title
Owner
Phone
(636) 561-5445

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2002002458 MO Primary

Addresses

Primary practice location

9016 Phoenix Pkwy
O Fallon, MO 63368-4278

Mailing address

7 Matterhorn CT
O Fallon, MO 63366-4804
Phone (314) 302-7100

National Provider Directory

National Provider Directory

Locations

9016 Phoenix Pkwy
O Fallon, MO 63368
Phone (636) 561-5445

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851448229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 MATTERHORN CT",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633664804",
            "telephone_number": "314-302-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9016 PHOENIX PKWY",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633684278",
            "telephone_number": "636-561-5445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD M. LOGAN, DDS, LC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "636-561-5445",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2002002458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, MO

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.