Provider Demographics
NPI:1710568654
Name:DANIEL E. LONG, DDS, LLC
Entity type:Organization
Organization Name:DANIEL E. LONG, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-435-9708
Mailing Address - Street 1:PO BOX 945
Mailing Address - Street 2:
Mailing Address - City:ANCHOR POINT
Mailing Address - State:AK
Mailing Address - Zip Code:99556-0945
Mailing Address - Country:US
Mailing Address - Phone:907-226-3700
Mailing Address - Fax:
Practice Address - Street 1:34115 STERLING HIGHWAY
Practice Address - Street 2:
Practice Address - City:ANCHOR POINT
Practice Address - State:AK
Practice Address - Zip Code:99556
Practice Address - Country:US
Practice Address - Phone:907-226-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1003506Medicaid