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General NPI Number Information
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NPI Number | 1336270149
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Entity Type | Organization
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Legal Business Name | LONGO & OMMEN, DDS, PC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4820 W TAFT RD STE 112
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City | LIVERPOOL
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State | NY
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Zip | 13088-2800
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Country | US
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Telephone | 315-457-3551
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Fax |
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Provider Business Mailing Address
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Address Line | 4820 W TAFT RD STE 112
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City | LIVERPOOL
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State | NY
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Zip | 13088-2800
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Country | US
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Telephone | 315-457-3551
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RONALD OMMEN
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Credential | DDS
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Telephone | 315-457-3551
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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 | 042172-1
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License Number State | NY
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