Individual
DR. JOSEPH LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 326-1297
Mailing address
611 W PARK ST, URBANA, IL 61801-2529
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
018.001998
IL
Other
Enumeration date
07/03/2016
Last updated
07/03/2016
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