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General NPI Number Information
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NPI Number | 1982215919
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Entity Type | Individual
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Provider Name | LONG KENNETH KHUU DMD
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Gender | Male
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Dates
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Enumeration Date | 08/13/2020
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 3101 W MICHIGAN AVE STE E
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City | PENSACOLA
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State | FL
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Zip | 32526-1876
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Country | US
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Telephone | 850-972-1841
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Fax |
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Provider Business Mailing Address
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Address Line | 410 W NINE MILE RD
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City | PENSACOLA
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State | FL
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Zip | 32534-1954
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Country | US
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Telephone | 850-462-5333
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Fax | 850-462-5888
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 24930
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License Number State | FL
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