Provider Demographics
NPI:1699893826
Name:LONG, LOWELL KENT (DDS)
Entity type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:KENT
Last Name:LONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 EICHER ST
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-2420
Mailing Address - Country:US
Mailing Address - Phone:319-524-3467
Mailing Address - Fax:
Practice Address - Street 1:1223 S GEAR AVE
Practice Address - Street 2:EASTMAN PLAZA, SUITE 302
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1682
Practice Address - Country:US
Practice Address - Phone:319-753-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA73241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice