MEDICARE: DR. RICHARD L. DELONG 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	0401008037	VA

General Provider Information

NPI Number	:	1629054226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD L. DELONG D.D.S.

Provider Business Mailing Address
First Line	:	933 INDIAN CIR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-4562
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1183 WEEKSVILLE RD
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-8437
Country	:	US
Telephone Number	:	252-335-6460
Fax Number	:

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	07/08/2007

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