Individual
DR. CHARLES ANTHONY LONG
Active
Individual
DR. CHARLES ANTHONY LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
00204758
CO
122300000X
Dentist
38187
TX
122300000X
Dentist
42724
TX
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
00204758
CO
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
38187
TX
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
42724
TX
Other
Enumeration date
06/23/2021
Last updated
07/14/2026
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