Provider Demographics
NPI:1225844772
Name:LONG, GRIFFIN (DMD)
Entity type:Individual
Prefix:
First Name:GRIFFIN
Middle Name:
Last Name:LONG
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 1:280 N SAND PALM RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439-3731
Mailing Address - Country:US
Mailing Address - Phone:831-601-5531
Mailing Address - Fax:
Practice Address - Street 1:2782 2ND ST NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-1469
Practice Address - Country:US
Practice Address - Phone:828-267-6858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program