Organization
DR. EVAN G. LONG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EVAN G. LONG DDS (OWNER)
(704) 795-2300
Entity
Organization
Contact information
Practice address
5641 POPLAR TENT RD, SUITE 201, CONCORD, NC 28027-7533
(704) 795-2300
(704) 795-2301
Mailing address
5641 POPLAR TENT RD, SUITE 201, CONCORD, NC 28027-7533
(704) 795-2300
(704) 795-2301
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
6693
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
799002T
—
NC
Enumeration date
07/29/2006
Last updated
09/25/2007
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