MEDICARE: ROBERT D 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
1	1223G0001X	General Practice Dentistry	6019	KS

General Provider Information

NPI Number	:	1881755197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT D LONG DDS

Provider Business Mailing Address
First Line	:	11111 NALL AVE
Second Line	:	SUITE 109
City	:	LEAWOOD
State	:	KS
Zip	:	66211-1620
Country	:	US
Telephone Number	:	913-491-3353
Fax Number	:	913-491-1042

Provider Business Practice Location Address
First Line	:	11111 NALL AVE
Second Line	:	SUITE 109
City	:	LEAWOOD
State	:	KS
Zip	:	66211-1620
Country	:	US
Telephone Number	:	913-491-3353
Fax Number	:	913-491-1042

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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