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General NPI Number Information
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NPI Number | 1922190826
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Entity Type | Organization
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Legal Business Name | NORMA M LONGO DMD PC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 02/14/2014
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Provider Practice Location Address
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Address Line | 15435 GLENEAGLE DR STE 200 220
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City | CO SP
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State | CO
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Zip | 80921
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Country | US
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Telephone | 719-481-6788
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Fax | 719-488-6585
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Provider Business Mailing Address
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Address Line | 15435 GLENEAGLE DR STE 200 220
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City | CO SP
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State | CO
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Zip | 80921
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Country | US
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Telephone | 719-481-6788
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Fax | 719-488-6585
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NORMA MONICA LONGO
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Credential | DHD
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Telephone | 719-481-6288
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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 | 6519
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License Number State | CO
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