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Organization

JERRY J LONG DDS PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JERRY J LONG DDS (PRESIDENT)
(601) 894-4732
Entity
Organization

Contact information

Practice address
240 CALDWELL DR, HAZLEHURST, MS 39083-2723
(601) 894-4732
(601) 894-4732
Mailing address
PO BOX 587, HAZLEHURST, MS 39083-0587
(601) 894-4732
(607) 894-4732

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
925-59
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
09015478
MS
Enumeration date
03/01/2010
Last updated
03/01/2010
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