Provider Demographics
NPI:1265736284
Name:LONG, RASCHEDA DENISE (DDS)
Entity type:Individual
Prefix:DR
First Name:RASCHEDA
Middle Name:DENISE
Last Name:LONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 SHERMAN COURT
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013
Mailing Address - Country:US
Mailing Address - Phone:214-923-6902
Mailing Address - Fax:
Practice Address - Street 1:979 GARDEN PARK DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3742
Practice Address - Country:US
Practice Address - Phone:214-383-9406
Practice Address - Fax:214-383-9480
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice