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General NPI Number Information
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NPI Number | 1780043018
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Entity Type | Organization
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Legal Business Name | ROBERT D. LONG DDS, PA
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 02/15/2016
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Provider Practice Location Address
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Address Line | 11111 NALL AVE STE 109
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City | LEAWOOD
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State | KS
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Zip | 66211-1625
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Country | US
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Telephone | 913-491-3353
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Fax | 913-491-1042
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Provider Business Mailing Address
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Address Line | 11111 NALL AVE STE 109
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City | LEAWOOD
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State | KS
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Zip | 66211-1625
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Country | US
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Telephone | 913-491-3353
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Fax | 913-491-1042
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. ROBERT D LONG
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Credential | DDS
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Telephone | 913-491-3353
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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 | KS 6019
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License Number State | KS
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