| NPI | 1790887826 |
|---|---|
| Former Name | LORI E LOGSDON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2004013332) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019026544) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2007-07-08 |