Provider Demographics
NPI:1699941716
Name:NORMA M LONGO DMD PC
Entity type:Organization
Organization Name:NORMA M LONGO DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:MONICA
Authorized Official - Last Name:LONGO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:719-481-6788
Mailing Address - Street 1:15435 GLENEAGLE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921
Mailing Address - Country:US
Mailing Address - Phone:719-481-6788
Mailing Address - Fax:719-488-6585
Practice Address - Street 1:15435 GLENEAGLE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921
Practice Address - Country:US
Practice Address - Phone:719-481-6788
Practice Address - Fax:719-488-6585
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORMA M LONGO DMD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO65191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty