Individual
LORY ANNE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
615 10TH ST S, LA CROSSE, WI 54601-4768
(608) 782-4054
Mailing address
1105 JEFFERSON AVE, SPARTA, WI 54656-2019
(608) 386-5859
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
9727-16
WI
Other
Enumeration date
03/10/2009
Last updated
03/10/2009
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