Individual
DR. ROBERT EARL LONG SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
527 DESOTO AVE, CLARKSDALE, MS 38614-5216
(662) 627-2565
(662) 627-2524
Mailing address
527 DESOTO AVE, CLARKSDALE, MS 38614-5216
(662) 627-2565
(662) 627-2524
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
186980
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00064885
—
MS
Enumeration date
12/17/2007
Last updated
12/17/2007
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