MEDICARE: RICHARD J LONG DMD

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	122300000X	Dentist	044602	NY

General Provider Information

NPI Number	:	1760633796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD J LONG DMD

Provider Business Mailing Address
First Line	:	PO BOX 287
Second Line	:	339 BROADWAY
City	:	FORT EDWARD
State	:	NY
Zip	:	12828-1233
Country	:	US
Telephone Number	:	518-747-3300
Fax Number	:	518-746-1049

Provider Business Practice Location Address
First Line	:	339 BROADWAY
Second Line	:
City	:	FORT EDWARD
State	:	NY
Zip	:	12828-1233
Country	:	US
Telephone Number	:	518-747-3300
Fax Number	:

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

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	10/08/2008

Similar Medicare Providers

1063414308 — DR. PATRICIA L. HALE I MD, PHD, FACP
Practice Location Address:

321 BROADWAY
FORT EDWARD, NY
12828-1233

Practice Phone: 518-747-1041
Practice Fax: 518-747-1022

1356322564 — CHARLENE HARRINGTON PA
Practice Location Address:

327 BROADWAY , FORT EDWARD INTERNAL MEDICINE
FORT EDWARD, NY
12828-1233

Practice Phone: 518-747-1041
Practice Fax: 518-747-1022

1811415789 — JAMIE D BOVAIR ANP
Practice Location Address:

327 BROADWAY
FORT EDWARD, NY
12828-1233

Practice Phone: 518-747-1041
Practice Fax: 518-747-1022

1700881869 — MRS. LAURA KOENIG M.D.
Practice Location Address:

500 MCMILLEN ST
FORT ATKINSON, WI
53538-1233

Practice Phone: 920-563-5571
Practice Fax: 920-563-7705

1912971243 — WILLIAM J CANNON MD
Practice Location Address:

500 MCMILLEN ST
FORT ATKINSON, WI
53538-1233

Practice Phone: 920-563-5571
Practice Fax:

1770558066 — INTERNAL MEDICINE & PEDIATRICS, S.C.
Practice Location Address:

500 MCMILLEN ST
FORT ATKINSON, WI
53538-1233

Practice Phone: 920-563-7711
Practice Fax: 920-563-7705

Directions to “ RICHARD J LONG DMD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.