Healthcare Provider Details

I. General information

NPI: 1699876821
Provider Name (Legal Business Name): PAUL A LONGO DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31099 CHAGRIN BLVD STE 100
PEPPER PIKE OH
44124-5959
US

IV. Provider business mailing address

31099 CHAGRIN BLVD STE 100
PEPPER PIKE OH
44124-5959
US

V. Phone/Fax

Practice location:
  • Phone: 216-450-5888
  • Fax: 216-450-5505
Mailing address:
  • Phone: 216-450-5888
  • Fax: 216-450-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number30.027829
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDEN02629
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: