Healthcare Provider Details

I. General information

NPI: 1558360974
Provider Name (Legal Business Name): LONG ,LAXER & SAVAGE DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7820 BALLANTYNE COMMONS PKWY SUITE 200
CHARLOTTE NC
28277-2841
US

IV. Provider business mailing address

7820 BALLANTYNE COMMONS PKWY SUITE 200
CHARLOTTE NC
28277-2841
US

V. Phone/Fax

Practice location:
  • Phone: 704-759-0000
  • Fax: 704-759-9937
Mailing address:
  • Phone: 704-759-0000
  • Fax: 704-759-9937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0138
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0138
License Number StateNC

VIII. Authorized Official

Name: DR. LINWOOD MARVIN LONG JR.
Title or Position: DENTIST / ORTHODONTIST
Credential: DDS, MS, D. ORTHO
Phone: 704-759-0000