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General NPI Number Information
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NPI Number | 1750316725
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Entity Type | Organization
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Legal Business Name | DAVID SCOTT LONG DMD LLC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 07/23/2014
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Provider Practice Location Address
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Address Line | 1290 WESTGATE PKWY
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City | DOTHAN
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State | AL
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Zip | 36303-2153
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Country | US
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Telephone | 334-712-1224
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Fax | 334-712-0050
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Provider Business Mailing Address
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Address Line | 1290 WESTGATE PKWY
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City | DOTHAN
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State | AL
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Zip | 36303-2153
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Country | US
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Telephone | 334-712-1224
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Fax | 334-712-0050
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Authorized Official
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Title or Position | LLC MANAGER & PRESIDENT
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Name | DR. DAVID SCOTT LONG
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Credential | DMD LLC
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Telephone | 334-712-1224
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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 | 4527
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License Number State | AL
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