Provider Demographics
NPI:1710142997
Name:LONG, CHRISTIAN MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:MICHAEL
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 1:920 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-1826
Mailing Address - Country:US
Mailing Address - Phone:814-643-4757
Mailing Address - Fax:
Practice Address - Street 1:920 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-1826
Practice Address - Country:US
Practice Address - Phone:814-643-4757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-27
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0375221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice