Provider Demographics
NPI:1104048289
Name:KASSIS LONG FAMILY DENTISTRY
Entity type:Organization
Organization Name:KASSIS LONG FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:KASSIS
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-556-7444
Mailing Address - Street 1:10 FARMFIELD AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7756
Mailing Address - Country:US
Mailing Address - Phone:843-556-7444
Mailing Address - Fax:843-556-7565
Practice Address - Street 1:10 FARMFIELD AVE
Practice Address - Street 2:SUITE D
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7756
Practice Address - Country:US
Practice Address - Phone:843-556-7444
Practice Address - Fax:843-556-7565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty