Individual
EDWARD LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2402 E MAIN ST, SUITE 8, MERRILL, WI 54452-2702
(715) 539-0441
Mailing address
2402 E MAIN ST, SUITE 8, MERRILL, WI 54452-2702
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5766015
WI
Other
Enumeration date
08/10/2007
Last updated
08/10/2007
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