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General NPI Number Information
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NPI Number | 1376954248
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Entity Type | Organization
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Legal Business Name | VINCENT LONGO DMD
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 2300 PENNSYLVANIA AVE SUITE 4A
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City | WILMINGTON
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State | DE
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Zip | 19806-1392
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Country | US
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Telephone | 302-654-7362
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Fax | 302-654-1070
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Provider Business Mailing Address
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Address Line | 2300 PENNSYLVANIA AVE SUITE 4A
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City | WILMINGTON
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State | DE
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Zip | 19806-1392
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Country | US
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Telephone | 302-654-7362
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Fax | 302-654-1070
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARIE TUTTLE
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Credential |
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Telephone | 302-654-7362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | G10001123
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License Number State | DE
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