Individual
DENISE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3650 STEWART AVE, WAUSAU, WI 54401-3944
(715) 845-3171
Mailing address
3650 STEWART AVE, WAUSAU, WI 54401-3944
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5762015
WI
Other
Enumeration date
08/10/2007
Last updated
08/10/2007
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