Organization
DENNIS R. LONG, M.D. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDI WILLIAMSON (OFFICE MANAGER)
(951) 532-5005
Entity
Organization
Contact information
Practice address
2601 E CHAPMAN AVE, ORANGE, CA 92869-3206
(951) 532-5005
Mailing address
PO BOX 68, NORCO, CA 92860-0068
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
00G472430
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G472430
BLUE CROSS/SHIELD
CA
05
—
00G472430
—
CA
01
—
HG47243
TRICARE
CA
Enumeration date
09/20/2006
Last updated
04/16/2009
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