Individual
PATRICK W LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3775 CENTRAL AVE, SHADYSIDE, OH 43947
(740) 676-2604
(740) 676-8714
Mailing address
PO BOX 147, SHADYSIDE, OH 43947-0147
(740) 676-2604
(740) 676-8714
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
17545
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0579066
—
OH
Enumeration date
10/05/2006
Last updated
08/08/2012
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