Provider Demographics
NPI:1912987538
Name:LONG, TROY L III (DDS)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:L
Last Name:LONG
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:212 N CASTLE HEIGHTS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2740
Mailing Address - Country:US
Mailing Address - Phone:615-444-2782
Mailing Address - Fax:615-444-4354
Practice Address - Street 1:212 N CASTLE HEIGHTS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2740
Practice Address - Country:US
Practice Address - Phone:615-444-2782
Practice Address - Fax:615-444-4354
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0053651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice