Individual
MISS JACKIE SOON LONGMIRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
238 FRONT ST, CASHTON, WI 54619-2002
(608) 654-5100
Mailing address
12735 US HIGHWAY 61, SOLDIERS GROVE, WI 54655-6000
(608) 632-3641
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
11175-16
WI
Other
Enumeration date
01/19/2013
Last updated
01/19/2013
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