Provider Demographics
NPI:1821071135
Name:LI, XIANG LONG (DDS MA PC)
Entity Type:Individual
Prefix:DR
First Name:XIANG LONG
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:DDS MA PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 E 50TH ST
Mailing Address - Street 2:9TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6817
Mailing Address - Country:US
Mailing Address - Phone:212-223-3005
Mailing Address - Fax:212-421-9299
Practice Address - Street 1:18 E 50TH ST
Practice Address - Street 2:9TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-6817
Practice Address - Country:US
Practice Address - Phone:212-223-3005
Practice Address - Fax:212-421-9299
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0460131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice