Healthcare Provider Details

I. General information

NPI: 1194527499
Provider Name (Legal Business Name): ALEXANDER HAMPTON LONG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7481 NORTHSIDE DR STE A
NORTH CHARLESTON SC
29420-4282
US

IV. Provider business mailing address

7481 NORTHSIDE DR STE A
NORTH CHARLESTON SC
29420-4282
US

V. Phone/Fax

Practice location:
  • Phone: 843-863-8634
  • Fax:
Mailing address:
  • Phone: 843-863-8634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11455
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: