Healthcare Provider Details

I. General information

NPI: 1902739154
Provider Name (Legal Business Name): MARC LONGE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8320 GREEN RD
FENTON MI
48430-9037
US

IV. Provider business mailing address

8320 GREEN RD
FENTON MI
48430-9037
US

V. Phone/Fax

Practice location:
  • Phone: 810-355-5702
  • Fax:
Mailing address:
  • Phone: 810-355-5702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901603020
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: