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General NPI Number Information
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NPI Number | 1265736284
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Entity Type | Individual
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Provider Name | RASCHEDA DENISE LONG D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 979 GARDEN PARK DR
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City | ALLEN
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State | TX
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Zip | 75013-3742
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Country | US
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Telephone | 214-383-9406
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Fax | 214-383-9480
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Provider Business Mailing Address
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Address Line | 1308 SHERMAN COURT
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City | ALLEN
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State | TX
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Zip | 75013
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Country | US
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Telephone | 214-923-6902
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 26193
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License Number State | TX
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