Individual
DR. JEREMIAH LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
921 STATE ST, NEW HAVEN, CT 06511-3926
(203) 858-8292
Mailing address
921 STATE ST, NEW HAVEN, CT 06511-3926
(203) 858-8292
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7944
CT
Other
Enumeration date
05/29/2007
Last updated
07/08/2007
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