Richard J Long, DMD
Dentist in Fort Edward, NY. Individual provider (NPI-1).
NPI number1760633796
StatusActive
Last updated in NPPESOct 8, 2008
Details
- NPI
- 1760633796
- Entity type
- Individual (NPI-1)
- Name
- Richard J Long
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Oct 8, 2008
- Last updated
- Oct 8, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 044602 | NY | Yes |
Practice location
339 BroadwayFort Edward, NY 12828-1233
Phone 518-747-3300
Mailing address
Po Box 287339 Broadway
Fort Edward, NY 12828-1233
Phone 518-747-3300 · Fax 518-746-1049
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