| Long Family Dentistry Inc | |
|
527 Desoto Avenue Clarksdale MS 38614 | |
| (662) 627-2565 | |
| (662) 627-2524 |
| Full Name | Long Family Dentistry Inc |
|---|---|
| Speciality | Dentist |
| Location | 527 Desoto Avenue, Clarksdale, Mississippi |
| Authorized Official Name and Position | Robert E Long (PRESIDENT DENTIST) |
| Authorized Official Contact | 6626272565 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Long Family Dentistry Inc Post Office Box 291 Clarksdale MS 38614 Ph: (662) 627-2565 | Long Family Dentistry Inc 527 Desoto Avenue Clarksdale MS 38614 Ph: (662) 627-2565 |
| NPI Number | 1811050313 |
|---|---|
| Provider Enumeration Date | 12/18/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811050313 | NPI | - | NPPES |
| 00064885 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 186980 (Mississippi) | Primary |
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