Individual provider · Type 1 NPI

Logan Collins Banner, DDS

Oral and Maxillofacial Surgery (Dentist) · Shreveport, LA

NPI number 1740577592 Active

Practice location

2120 Bert Kouns Industrial Loop Ste D
Shreveport, LA 71118-3351

Call (318) 687-9800 Map

Mailing address

5718 Marina Bay Dr
Shreveport, LA 71119-3918

Other practice locations

  • 8540 1st Ave NW # 8, Seattle, WA 98117-3059 · (206) 801-3900

Specialties and licenses

TaxonomyCodeLicense
Dentist 122300000XDE60226297 (WA)
Oral and Maxillofacial Surgery (Dentist) 1223S0112X32707 (TX)
Oral and Maxillofacial Surgery (Dentist) Primary 1223S0112X7046 (LA)

Oral and Maxillofacial Surgery (Dentist): 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.

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About NPI 1740577592

Logan Collins Banner, DDS's National Provider Identifier is 1740577592, issued on Jun 30, 2011. The primary taxonomy on file is Oral and Maxillofacial Surgery (Dentist) (1223S0112X), and the practice location is in Shreveport, LA. The record was last updated on Jul 28, 2024.