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General NPI Number Information
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NPI Number | 1821183377
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Entity Type | Individual
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Provider Name | MICHAEL LONGO D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 310 MAIN STREET
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City | EAST HAVEN
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State | CT
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Zip | 06512
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Country | US
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Telephone | 203-469-8057
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Fax | 203-469-8058
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Provider Business Mailing Address
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Address Line | 310 MAIN STREET
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City | EAST HAVEN
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State | CT
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Zip | 06512
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Country | US
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Telephone | 203-469-8057
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Fax | 203-469-8058
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 8159
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License Number State | CT
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