Provider Demographics
NPI:1508534025
Name:LONGO, ZACHARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:
Last Name:LONGO
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 1:181 BURR RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2729
Mailing Address - Country:US
Mailing Address - Phone:203-525-8026
Mailing Address - Fax:
Practice Address - Street 1:CANNON AIR FORCE BASE
Practice Address - Street 2:27 SPECIAL OPERATIONS MEDICAL READINESS SQUADRON
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:88013
Practice Address - Country:US
Practice Address - Phone:240-612-2665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD22023122300000X
CT13147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist