Provider Demographics
NPI:1952628257
Name:DELONG, BRENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:DELONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 COX RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0632
Mailing Address - Country:US
Mailing Address - Phone:704-865-7603
Mailing Address - Fax:704-865-6411
Practice Address - Street 1:571 COX RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0632
Practice Address - Country:US
Practice Address - Phone:704-865-7603
Practice Address - Fax:704-865-6411
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106281223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery