Healthcare Provider Details

I. General information

NPI: 1083637797
Provider Name (Legal Business Name): ROSS EUGENE LONG JR. DMD, MS, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N LIME ST
LANCASTER PA
17602-2748
US

IV. Provider business mailing address

223 N LIME ST
LANCASTER PA
17602-2748
US

V. Phone/Fax

Practice location:
  • Phone: 717-394-3793
  • Fax: 717-396-7409
Mailing address:
  • Phone: 717-394-3793
  • Fax: 717-396-7409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS018611
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: