Individual
DR. LARRY KEITH LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS,MD
Contact information
Practice address
2624 JENKS AVE STE 1, PANAMA CITY, FL 32405
(210) 667-5171
Mailing address
2624 JENKS AVE STE 1, PANAMA CITY, FL 32405-4311
(210) 667-5171
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
23649
TX
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
6538
NC
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DN23806
FL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
DN23806
FL
Other
Enumeration date
09/07/2005
Last updated
11/30/2020
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