# LONGEVITY DENTAL

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

## Provider details

- **NPI number:** 1669989240
- **Authorized official:** RONALD G EVANS (SOLE MBR)
- **Authorized official phone:** (972) 771-0977

## Contact information

- **Practice address:** 510 TURTLE COVE BLVD STE 107, ROCKWALL, TX 75087-5374
- **Practice address phone:** (972) 771-0977
- **Mailing address:** 510 TURTLE COVE BLVD STE 107, ROCKWALL, TX 75087-5374

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 17186 | TX | Yes |

## Other

- **Enumeration date:** 01/05/2018
- **Last updated:** 01/05/2018