Diana Marie Long, DDS

NPI #1124391347 in Madison, Mississippi

Provider Information

NPI Number: 1124391347
Entity Type: Individual
Name: Diana Marie Long, DDS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Student in an Organized Health Care Education/Training Program
Credential: DDS
Enumeration Date: Feb 18, 2012
Last Updated: Nov 28, 2016

Practice Location

Address: 504 NEWBURY DR
City: Madison
State: Mississippi
ZIP Code: 39110-4574
Phone: (256) 335-7042

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Student in an Organized Health Care Education/Training Program	390200000X	Primary
Dentist	122300000X

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