Individual
ROBERT W LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MSD
Contact information
Practice address
2705 S BERKLEY, BUILDING 2 SUITE B, KOKOMO, IN 46902-8007
(765) 453-2267
(765) 453-1150
Mailing address
2705 S BERKLEY, BUILDING 2 SUITE B, KOKOMO, IN 46902-8007
(765) 453-2267
(765) 453-1150
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
12010170A
IN
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
12010170A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12010170A
DENTAL LICENSE
IN
Enumeration date
11/01/2006
Last updated
09/11/2025
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