Individual
JACOB LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1611 GREENFIELD ST, WILMINGTON, NC 28401-6455
(910) 342-9210
Mailing address
1611 GREENFIELD ST, WILMINGTON, NC 28401-6455
(910) 342-9210
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10411
NC
Other
Enumeration date
05/04/2016
Last updated
07/13/2016
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