Provider Demographics
NPI:1922190826
Name:NORMA M LONGO DMD PC
Entity Type:Organization
Organization Name:NORMA M LONGO DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:MONICA
Authorized Official - Last Name:LONGO
Authorized Official - Suffix:
Authorized Official - Credentials:DHD
Authorized Official - Phone:719-481-6288
Mailing Address - Street 1:15435 GLENEAGLE DR
Mailing Address - Street 2:STE 200 220
Mailing Address - City:CO SP
Mailing Address - State:CO
Mailing Address - Zip Code:80921
Mailing Address - Country:US
Mailing Address - Phone:719-481-6788
Mailing Address - Fax:719-488-6585
Practice Address - Street 1:15435 GLENEAGLE DR
Practice Address - Street 2:STE 200 220
Practice Address - City:CO SP
Practice Address - State:CO
Practice Address - Zip Code:80921
Practice Address - Country:US
Practice Address - Phone:719-481-6788
Practice Address - Fax:719-488-6585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6519122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty