Individual
DR. SHAWN RAY LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
16329 STATE RD 23, SOUTH BEND, IN 46635
(574) 243-8843
(574) 243-8845
Mailing address
16329 STATE RD 23, SOUTH BEND, IN 46635
(574) 243-8843
(574) 243-8845
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12009672
IN
Other
Enumeration date
11/29/2006
Last updated
07/08/2007
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