Healthcare Provider Details

I. General information

NPI: 1932261328
Provider Name (Legal Business Name): NORMA MONICA LONGO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15435 GLENEAGLE DR
COLORADO SPRINGS CO
80921
US

IV. Provider business mailing address

8842 ALPINE VALLEY DR
COLORADO SPRINGS CO
80920-7313
US

V. Phone/Fax

Practice location:
  • Phone: 719-481-6788
  • Fax: 719-488-6585
Mailing address:
  • Phone: 719-282-1609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6519
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: