Provider Demographics
NPI:1073637559
Name:LONG, FRANK ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:ALLEN
Last Name:LONG
Suffix:
Gender:F
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:PO BOX 624
Mailing Address - Street 2:41630 COURTHOUSE DRIVE
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-0624
Mailing Address - Country:US
Mailing Address - Phone:301-475-3305
Mailing Address - Fax:
Practice Address - Street 1:41630 COURTHOUSE STREET
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-0624
Practice Address - Country:US
Practice Address - Phone:301-475-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD85881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice