Individual
DR. ETHAN MICHAEL LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2946 WINFIELD DUNN PKWY, SUITE 301, KODAK, TN 37764-4306
(865) 465-7058
(865) 465-3432
Mailing address
2946 WINFIELD DUNN PKWY, SUITE 301, KODAK, TN 37764-4306
(865) 465-7058
(865) 465-3432
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10270
TN
Other
Enumeration date
06/07/2016
Last updated
06/07/2016
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