Provider Demographics
NPI:1134610975
Name:JONES, LOGAN T (DDS)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:T
Last Name:JONES
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 1:1300 SLACK ST
Mailing Address - Street 2:
Mailing Address - City:PEA RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72751-3914
Mailing Address - Country:US
Mailing Address - Phone:479-488-6131
Mailing Address - Fax:479-488-3215
Practice Address - Street 1:1300 SLACK ST
Practice Address - Street 2:
Practice Address - City:PEA RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72751-3914
Practice Address - Country:US
Practice Address - Phone:479-488-6131
Practice Address - Fax:479-488-6215
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180175391223G0001X
AR42761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4276OtherAR LICENSE
MO2018017539OtherMO LICENSE
AR4276OtherAR LICENSE