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General NPI Number Information
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NPI Number | 1558360974
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Entity Type | Organization
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Legal Business Name | LONG ,LAXER & SAVAGE DDS, PLLC
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 7820 BALLANTYNE COMMONS PKWY SUITE 200
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City | CHARLOTTE
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State | NC
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Zip | 28277-2841
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Country | US
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Telephone | 704-759-0000
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Fax | 704-759-9937
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Provider Business Mailing Address
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Address Line | 7820 BALLANTYNE COMMONS PKWY SUITE 200
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City | CHARLOTTE
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State | NC
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Zip | 28277-2841
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Country | US
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Telephone | 704-759-0000
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Fax | 704-759-9937
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Authorized Official
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Title or Position | DENTIST / ORTHODONTIST
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Name | DR. LINWOOD MARVIN LONG JR.
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Credential | DDS, MS, D. ORTHO
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Telephone | 704-759-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0138
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0138
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License Number State | NC
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