Provider Demographics
NPI:1548333818
Name:LONG, LINWOOD (DDS, MS, D ORT)
Entity type:Individual
Prefix:DR
First Name:LINWOOD
Middle Name:
Last Name:LONG
Suffix:
Gender:M
Credentials:DDS, MS, D ORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7820 BALLANTYNE COMMONS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2889
Mailing Address - Country:US
Mailing Address - Phone:704-759-0000
Mailing Address - Fax:704-759-9937
Practice Address - Street 1:7820 BALLANTYNE COMMONS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2889
Practice Address - Country:US
Practice Address - Phone:704-759-0000
Practice Address - Fax:704-759-9937
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC42211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8995372Medicaid