Provider Demographics
NPI:1366739401
Name:MORSE, LOGAN LEE (DDS)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:LEE
Last Name:MORSE
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 1:1133 COLLEGE AVE
Mailing Address - Street 2:SUITE D202
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2964
Mailing Address - Country:US
Mailing Address - Phone:785-539-7401
Mailing Address - Fax:785-776-8415
Practice Address - Street 1:1133 COLLEGE AVE
Practice Address - Street 2:SUITE D202
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2964
Practice Address - Country:US
Practice Address - Phone:785-539-7401
Practice Address - Fax:785-776-8415
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS608321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice