Healthcare Provider Details

I. General information

NPI: 1609565274
Provider Name (Legal Business Name): AMBER NICOLE LONG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W MCLEAN ST
SAINT PAULS NC
28384-1726
US

IV. Provider business mailing address

2028 LITHO PL STE 300
FAYETTEVILLE NC
28304-2538
US

V. Phone/Fax

Practice location:
  • Phone: 910-446-1130
  • Fax:
Mailing address:
  • Phone: 910-485-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14209
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: