Provider Demographics
NPI:1295889624
Name:LONGO, PAUL JOSEPH (DDS DENTIST)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:LONGO
Suffix:
Gender:M
Credentials:DDS DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 WEST TAFT ROAD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088
Mailing Address - Country:US
Mailing Address - Phone:315-457-3551
Mailing Address - Fax:315-457-3581
Practice Address - Street 1:4820 WEST TAFT ROAD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088
Practice Address - Country:US
Practice Address - Phone:315-457-3551
Practice Address - Fax:315-457-3581
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice