Provider Demographics
NPI:1982215919
Name:KHUU, LONG KENNETH (DMD)
Entity type:Individual
Prefix:
First Name:LONG
Middle Name:KENNETH
Last Name:KHUU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W NINE MILE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-1954
Mailing Address - Country:US
Mailing Address - Phone:850-462-5333
Mailing Address - Fax:850-462-5888
Practice Address - Street 1:3101 W MICHIGAN AVE STE E
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-1876
Practice Address - Country:US
Practice Address - Phone:850-972-1841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist