Individual
GARRETT ISAAC LONG III
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
17978 SR 55, BAKER, WV 26801
(304) 897-5915
(304) 897-6216
Mailing address
RR 1 BOX 92A11, AUGUSTA, WV 26704-9728
(304) 496-7750
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2832
WV
Other
Enumeration date
05/04/2006
Last updated
07/08/2007
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