Provider Demographics
NPI:1295270916
Name:LONGVILLE, VERONICA (DDS)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:LONGVILLE
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 1:4601 ADONICA LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9658
Mailing Address - Country:US
Mailing Address - Phone:210-621-3713
Mailing Address - Fax:
Practice Address - Street 1:2715 PINEDALE RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4713
Practice Address - Country:US
Practice Address - Phone:336-379-8377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC120891223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty