Provider Demographics
NPI:1598898801
Name:LONG, WILLIAM GREGORY (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GREGORY
Last Name:LONG
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 1:3650 GURLEY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-5623
Mailing Address - Country:US
Mailing Address - Phone:706-571-0201
Mailing Address - Fax:706-320-0390
Practice Address - Street 1:3650 GURLEY DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5623
Practice Address - Country:US
Practice Address - Phone:706-571-0201
Practice Address - Fax:706-320-0390
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10043122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist