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General NPI Number Information
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NPI Number | 1932212032
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Entity Type | Individual
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Provider Name | DAVID ROBERT DE LONG DDS
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Gender | Male
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1230 SCOTT BLVD
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City | SANTA CLARA
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State | CA
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Zip | 95050-4517
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Country | US
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Telephone | 408-243-5741
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Fax | 408-243-1484
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Provider Business Mailing Address
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Address Line | 1230 SCOTT BLVD
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City | SANTA CLARA
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State | CA
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Zip | 95050-4517
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Country | US
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Telephone | 408-243-5141
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Fax | 408-243-1484
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DU035867
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License Number State | CA
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