Individual
DR. GREGORY D LONG II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
7131 N KNOXVILLE AVE STE B, PEORIA, IL 61614-2088
(309) 692-2700
Mailing address
7131 N KNOXVILLE AVE STE B, PEORIA, IL 61614-2088
(309) 692-2700
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
021.003022
IL
Other
Enumeration date
03/03/2020
Last updated
03/03/2020
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