Organization
LONG FAMILY DENTISTRY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT E LONG SR. DDS (PRESIDENT DENTIST)
(662) 627-2565
Entity
Organization
Contact information
Practice address
527 DESOTO AVENUE, CLARKSDALE, MS 38614
(662) 627-2565
(662) 627-2524
Mailing address
POST OFFICE BOX 291, CLARKSDALE, MS 38614
(662) 627-2565
(662) 627-2524
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
186980
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00064885
—
MS
Enumeration date
12/18/2006
Last updated
08/22/2020
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