Healthcare Provider Details

I. General information

NPI: 1306886924
Provider Name (Legal Business Name): DANIEL EUGENE LONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 05/07/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34115 STERLING HIGHWAY
ANCHOR POINT AK
99556
US

IV. Provider business mailing address

PO BOX 945
ANCHOR POINT AK
99556-0945
US

V. Phone/Fax

Practice location:
  • Phone: 907-226-3700
  • Fax:
Mailing address:
  • Phone: 907-435-9708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1138
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: