Organization
LIFE LONG DENTAL CARE OF NORTHFORD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMIAH LONG D.M.D. (OWNER)
(203) 484-0456
Entity
Organization
Contact information
Practice address
1355 MIDDLETOWN AVE, NORTHFORD, CT 06472-1382
(203) 484-0456
(203) 484-4050
Mailing address
1355 MIDDLETOWN AVE, NORTHFORD, CT 06472-1382
(203) 484-0456
(203) 484-4050
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0300X
Periodontics
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
10/29/2013
Last updated
10/29/2013
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