Provider Demographics
NPI:1033595046
Name:LONG, STUART (DMD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:LONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1399 GALLERIA DR
Mailing Address - Street 2:200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6662
Mailing Address - Country:US
Mailing Address - Phone:702-433-0007
Mailing Address - Fax:702-435-4618
Practice Address - Street 1:1399 GALLERIA DR
Practice Address - Street 2:200
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6662
Practice Address - Country:US
Practice Address - Phone:702-433-0007
Practice Address - Fax:702-435-4618
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6689122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist