Organization
WILLIAM G LONG DDS,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM GOULD LONG DDS (OWNER)
(706) 737-0133
Entity
Organization
Contact information
Practice address
1810 CENTRAL AVE, AUGUSTA, GA 30904-5735
(706) 737-0133
Mailing address
1810 CENTRAL AVE, AUGUSTA, GA 30904
(706) 737-0133
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN009950
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00338269A
—
GA
Enumeration date
12/17/2007
Last updated
12/17/2007
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