Organization
JACOB R. LONG, DDS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB R. LONG DDS (DENTIST/OWNER)
(910) 762-0355
Entity
Organization
Contact information
Practice address
736 MEDICAL CENTER DR STE 101, WILMINGTON, NC 28401-4284
(910) 762-0255
Mailing address
736 MEDICAL CENTER DR STE 101, WILMINGTON, NC 28401-4284
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
10411
NC
Other
Enumeration date
08/09/2018
Last updated
08/09/2018
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