Organization
CRAIG C. LONGENECKER DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CRAIG CHARLES LONGENECKER D.D.S. (OWNER)
(443) 904-7836
Entity
Organization
Contact information
Practice address
16928 YORK RD, MONKTON, MD 21111-1042
(410) 357-0099
Mailing address
16928 YORK RD, MONKTON, MD 21111-1042
(410) 357-0099
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11730
DENTAL LICENSEE
MD
01
—
1932381977
PERSONAL NPI NUMBER
MD
Enumeration date
04/30/2015
Last updated
04/30/2015
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