| NPI | 1790295152 |
|---|---|
| Former Legal Business Name | GARY R. LOGIN DMD |
| Entity Type | Organization |
| Authorized Contact | JILLIAN BOXER Practice Administrator 857-707-6047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2025-02-11 |