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General NPI Number Information
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NPI Number | 1104048289
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Entity Type | Organization
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Legal Business Name | KASSIS LONG FAMILY DENTISTRY
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10 FARMFIELD AVE SUITE D
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City | CHARLESTON
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State | SC
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Zip | 29407-7756
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Country | US
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Telephone | 843-556-7444
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Fax | 843-556-7565
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Provider Business Mailing Address
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Address Line | 10 FARMFIELD AVE SUITE D
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City | CHARLESTON
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State | SC
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Zip | 29407-7756
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Country | US
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Telephone | 843-556-7444
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Fax | 843-556-7565
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JULIE KASSIS LONG
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Credential | D.M.D.
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Telephone | 843-556-7444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3790
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License Number State | SC
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