Individual
DR. AUDRA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, MS
Contact information
Practice address
1510 DOCTORS CT, WATERTOWN, WI 53094-4102
(920) 261-3560
Mailing address
1520 ROCKRIDGE WAY, WAUKESHA, WI 53188-8009
(920) 716-1513
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
1001200 - 15
WI
Other
Enumeration date
09/01/2015
Last updated
09/01/2015
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