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Individual

DR. WILLIAM RANDALL LONG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
9602 E WASHINGTON ST, SUITE C, INDIANAPOLIS, IN 46229-4504
(317) 899-5437
(317) 897-0771
Mailing address
9602 E WASHINGTON ST, SUITE C, INDIANAPOLIS, IN 46229-4504
(317) 899-5437
(317) 897-0771

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
12006619
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
145620
CSHCS
IN
01
429256
UNITED CONCORDIA
IN
Enumeration date
08/09/2006
Last updated
07/08/2007
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