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NPI Code Detail

MEDICARE: DR. JULIE KASSIS LONG D.M.D.

MEDICARE: DR. JULIE KASSIS LONG D.M.D.
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
11223G0001XGeneral Practice Dentistry3790SC

General Provider Information

NPI Number : 1558583617
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JULIE KASSIS LONG D.M.D.
Provider Business Mailing Address
First Line : 10 FARMFIELD AVE
Second Line : SUITE D
City : CHARLESTON
State : SC
Zip : 29407-7756
Country : US
Telephone Number : 843-556-7444
Fax Number : 843-556-7565
Provider Business Practice Location Address
First Line : 10 FARMFIELD AVE
Second Line : SUITE D
City : CHARLESTON
State : SC
Zip : 29407-7756
Country : US
Telephone Number : 843-556-7444
Fax Number : 843-556-7565
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 07/08/2007

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