Provider Demographics
NPI:1497252233
Name:LONG, RICHARD JONATHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JONATHAN
Last Name:LONG
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 1:8316 OLD CAVALRY DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4534
Mailing Address - Country:US
Mailing Address - Phone:804-726-0962
Mailing Address - Fax:
Practice Address - Street 1:9151 ESTATE THOMAS STE 203
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2716
Practice Address - Country:US
Practice Address - Phone:804-726-0962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401416395122300000X
390200000X
VI30871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program