Organization
LONGEVITY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD G EVANS (SOLE MBR)
(972) 771-0977
Entity
Organization
Contact information
Practice address
510 TURTLE COVE BLVD STE 107, ROCKWALL, TX 75087-5374
(972) 771-0977
Mailing address
510 TURTLE COVE BLVD STE 107, ROCKWALL, TX 75087-5374
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
17186
TX
Other
Enumeration date
01/05/2018
Last updated
01/05/2018
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