Provider Demographics
NPI:1982723656
Name:LONGO, ALFRED T (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:T
Last Name:LONGO
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:1710 N 144TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4715
Mailing Address - Country:US
Mailing Address - Phone:402-496-9733
Mailing Address - Fax:402-493-5975
Practice Address - Street 1:1710 N 144TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4715
Practice Address - Country:US
Practice Address - Phone:402-431-9446
Practice Address - Fax:402-493-5975
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE46941223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics