Provider Demographics
NPI:1861667537
Name:THOMAS E. LONG DDS II
Entity Type:Organization
Organization Name:THOMAS E. LONG DDS II
Other - Org Name:RALEIGH INSTITUTE FOR GENERAL DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-782-6237
Mailing Address - Street 1:2310 MYRON DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-3358
Mailing Address - Country:US
Mailing Address - Phone:919-782-6237
Mailing Address - Fax:919-782-7144
Practice Address - Street 1:2310 MYRON DR
Practice Address - Street 2:SUITE 220
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-3358
Practice Address - Country:US
Practice Address - Phone:919-782-6237
Practice Address - Fax:919-782-7144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6694261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental