MEDICARE: MICHAEL WALTER LONG D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN015318	GA

General Provider Information

NPI Number	:	1538234745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL WALTER LONG D.D.S.

Provider Business Mailing Address
First Line	:	7760 SAGEBRUSH DR
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-4734
Country	:	US
Telephone Number	:	760-861-9599
Fax Number	:

Provider Business Practice Location Address
First Line	:	7760 SAGEBRUSH DR
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-4734
Country	:	US
Telephone Number	:	760-861-9599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	05/31/2025

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