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Organization
JRL DENTAL DBA GRACE DENTAL CARE
Active
Organization
JRL DENTAL DBA GRACE DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON R LONG DDS (OWNER)
(304) 784-6665
Entity
Organization
Contact information
Practice address
15081 MACCORKLE AVE, CHELYAN, WV 25035
(304) 595-3551
(304) 595-6822
Mailing address
1628 W 3RD AVE, WILLIAMSON, WV 25661-3007
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/13/2019
Last updated
08/13/2019
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