# JRL DENTAL DBA GRACE DENTAL CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043866338
- **Authorized official:** DR. JASON R LONG DDS (OWNER)
- **Authorized official phone:** (304) 784-6665

## Contact information

- **Practice address:** 15081 MACCORKLE AVE, CHELYAN, WV 25035
- **Practice address phone:** (304) 595-3551
- **Practice address fax:** (304) 595-6822
- **Mailing address:** 1628 W 3RD AVE, WILLIAMSON, WV 25661-3007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 08/13/2019
- **Last updated:** 08/13/2019