Provider Demographics
NPI:1083637797
Name:LONG, ROSS EUGENE JR (DMD, MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:EUGENE
Last Name:LONG
Suffix:JR
Gender:M
Credentials:DMD, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N LIME ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2748
Mailing Address - Country:US
Mailing Address - Phone:717-394-3793
Mailing Address - Fax:717-396-7409
Practice Address - Street 1:223 N LIME ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2748
Practice Address - Country:US
Practice Address - Phone:717-394-3793
Practice Address - Fax:717-396-7409
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0186111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics