Provider Demographics
NPI:1174533376
Name:LOGUE, DENNIS CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:CHARLES
Last Name:LOGUE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4326 PARK BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3555
Mailing Address - Country:US
Mailing Address - Phone:727-541-3502
Mailing Address - Fax:727-544-6043
Practice Address - Street 1:4326 PARK BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3555
Practice Address - Country:US
Practice Address - Phone:727-541-3502
Practice Address - Fax:727-544-6043
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN129191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice