Provider Demographics
NPI:1699375543
Name:LONG FAMILY DENTAL
Entity Type:Organization
Organization Name:LONG FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-775-3192
Mailing Address - Street 1:4470 E HIGHWAY 287 STE 1200
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-7556
Mailing Address - Country:US
Mailing Address - Phone:972-775-3192
Mailing Address - Fax:972-775-3957
Practice Address - Street 1:4470 E HIGHWAY 287 STE 1200
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-7556
Practice Address - Country:US
Practice Address - Phone:972-775-3192
Practice Address - Fax:972-775-3957
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONG FAMILY DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty