Organization
ALEXANDRIA OLD TOWN DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDDIE SEYMOUR LONGMAN DDS (DENTIST/OWNER)
(703) 549-1331
Entity
Organization
Contact information
Practice address
1421 PRINCE ST STE 140, ALEXANDRIA, VA 22314-2771
(703) 549-1331
(703) 549-0480
Mailing address
1421 PRINCE ST STE 140, ALEXANDRIA, VA 22314-2771
(703) 549-1331
(703) 549-0480
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401004117
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
541192045
GENERAL DENTIST
VA
Enumeration date
01/31/2018
Last updated
09/08/2020
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