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General NPI Number Information
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NPI Number | 1699375543
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Entity Type | Organization
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Legal Business Name | LONG FAMILY DENTAL
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 4470 E HIGHWAY 287 STE 1200
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-7556
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Country | US
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Telephone | 972-775-3192
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Fax | 972-775-3957
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Provider Business Mailing Address
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Address Line | 4470 E HIGHWAY 287 STE 1200
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-7556
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Country | US
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Telephone | 972-775-3192
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Fax | 972-775-3957
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR
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Name | JULIE ANN LOVE
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Credential |
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Telephone | 972-775-3192
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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 |
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License Number State |
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