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NPI Code Detail

MEDICARE: LONG KENNETH KHUU DMD

MEDICARE:   LONG KENNETH KHUU  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
1122300000XDentist24930FL

General Provider Information

NPI Number : 1982215919
Entity Type Code : Individual
Provider Name (Legal Business Name) : LONG KENNETH KHUU DMD
Provider Business Mailing Address
First Line : 410 W NINE MILE RD
Second Line :
City : PENSACOLA
State : FL
Zip : 32534-1954
Country : US
Telephone Number : 850-462-5333
Fax Number : 850-462-5888
Provider Business Practice Location Address
First Line : 3101 W MICHIGAN AVE STE E
Second Line :
City : PENSACOLA
State : FL
Zip : 32526-1876
Country : US
Telephone Number : 850-972-1841
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2020
Last Update Date : 02/14/2025

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Directions to “ LONG KENNETH KHUU DMD” Practice Location

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