Provider Demographics
NPI:1558360974
Name:LONG ,LAXER & SAVAGE DDS, PLLC
Entity Type:Organization
Organization Name:LONG ,LAXER & SAVAGE DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LINWOOD
Authorized Official - Middle Name:MARVIN
Authorized Official - Last Name:LONG
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS, MS, D ORTHO
Authorized Official - Phone:704-759-0000
Mailing Address - Street 1:7820 BALLANTYNE COMMONS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2841
Mailing Address - Country:US
Mailing Address - Phone:704-759-0000
Mailing Address - Fax:704-759-9937
Practice Address - Street 1:7820 BALLANTYNE COMMONS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2841
Practice Address - Country:US
Practice Address - Phone:704-759-0000
Practice Address - Fax:704-759-9937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01381223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
148760706OtherDR. LONG'S ADA#
NC89902XAMedicaid
NC8995372Medicaid
NC9016KOtherDR. LAXER'S BCBS#
NC902XAOtherDR. SAVAGE'S BCBS#
NC899016KMedicaid
NC95372OtherDR. LONG'S BCBS#
143881557OtherDR. LAXER'S ADA#
NC95372OtherDR. LONG'S BCBS#
143881557OtherDR. LAXER'S ADA#
NCBL6914356OtherDR. LONG'S DEA#
NC902XAOtherDR. SAVAGE'S BCBS#