| Organization Name: | LOGAN ORAL SURGERY |
| NPI Number: | 1598024341 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SCOTT MATSON (OWNER) |
| Mailing Address: | 3125 N. Main Street Ste #103 North Logan |
| State: | UT US |
| Postal Code: | 843411550 |
| Phone Number: | 4357547130 |
| Fax Number: | 4355352464 |
| NPI Enumeration Date: | 05/15/2012 |
| NPI Last Update Date: | 04/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QS0112X |
| License Number: | 8227102-9924 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Oral and Maxillofacial Surgery |
| Taxonomy Definition: | The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |