Provider Demographics
NPI:1366266819
Name:CARTER, LOGAN CHASE (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:CHASE
Last Name:CARTER
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 PECAN RDG E
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-5012
Mailing Address - Country:US
Mailing Address - Phone:436-705-4475
Mailing Address - Fax:
Practice Address - Street 1:6491 JORDAN RD
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4728
Practice Address - Country:US
Practice Address - Phone:251-625-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.007391-C11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics