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Organization

LIFELONG FAMILY DENTISTRY PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BRIAN M. LONG D.D.S. (OWNER)
(734) 616-2288
Entity
Organization

Contact information

Practice address
8930 MACOMB ST, GROSSE ILE, MI 48138-1577
(734) 676-2288
Mailing address
8930 MACOMB ST, GROSSE ILE, MI 48138-1577
(734) 676-2288

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901016216
MI

Other

Enumeration date
09/22/2010
Last updated
09/22/2010
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