Provider Demographics
NPI:1053315317
Name:LONGLEY, JOHN EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:LONGLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 BOSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2334
Mailing Address - Country:US
Mailing Address - Phone:410-666-1213
Mailing Address - Fax:
Practice Address - Street 1:20 E TIMONIUM RD
Practice Address - Street 2:STE 210
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3456
Practice Address - Country:US
Practice Address - Phone:410-308-4880
Practice Address - Fax:410-308-4883
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice