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NPI Code Detail

MEDICARE: DR. THOMAS EDWARD LONG DDS

MEDICARE: DR. THOMAS EDWARD LONG DDS
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 Dentistry6694NC

General Provider Information

NPI Number : 1851395727
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS EDWARD LONG DDS
Provider Business Mailing Address
First Line : 2310 MYRON DR
Second Line :
City : RALEIGH
State : NC
Zip : 27607-3358
Country : US
Telephone Number : 919-782-6237
Fax Number : 919-782-7144
Provider Business Practice Location Address
First Line : 2310 MYRON DR
Second Line :
City : RALEIGH
State : NC
Zip : 27607-3358
Country : US
Telephone Number : 919-782-6237
Fax Number : 919-782-7144
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 04/24/2008

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Directions to “ DR. THOMAS EDWARD LONG DDS” Practice Location

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