Provider Demographics
NPI:1558583617
Name:LONG, JULIE KASSIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:KASSIS
Last Name:LONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FARMFIELD AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7756
Mailing Address - Country:US
Mailing Address - Phone:843-556-7444
Mailing Address - Fax:843-556-7565
Practice Address - Street 1:10 FARMFIELD AVE
Practice Address - Street 2:SUITE D
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7756
Practice Address - Country:US
Practice Address - Phone:843-556-7444
Practice Address - Fax:843-556-7565
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice