Provider Demographics
NPI:1184392300
Name:JRLONG, PLLC
Entity type:Organization
Organization Name:JRLONG, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-688-1713
Mailing Address - Street 1:9020 SENCA DR STE 210
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-6680
Mailing Address - Country:US
Mailing Address - Phone:910-756-5100
Mailing Address - Fax:888-756-7425
Practice Address - Street 1:9020 SENCA DR STE 210
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-6680
Practice Address - Country:US
Practice Address - Phone:910-756-5100
Practice Address - Fax:888-756-7425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center