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Organization

NEVADA FAMILY DENTISTRY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ROBERT STEPHEN LONG DDS (MEMBER)
(417) 667-3006
Entity
Organization

Contact information

Practice address
402 E WALNUT ST, NEVADA, MO 64772-2458
(417) 667-3006
(417) 667-4579
Mailing address
402 E WALNUT ST, NEVADA, MO 64772-2458
(417) 667-3006
(417) 667-4579

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
011960
MO

Other

Enumeration date
02/11/2009
Last updated
02/11/2009
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