Jacob R. Long, DDS, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

10411 Issued in NC

Legal business name

JACOB R. LONG, DDS, PLLC

Practice address

736 Medical Center Dr Ste 101
Wilmington, NC 28401-4284

Phone

(910) 762-0255

NPI assigned

Aug 9, 2018

Last updated

Aug 9, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jacob R. Long, DDS

Title

Dentist/Owner

Phone

(910) 762-0355

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533772800000",
    "number": "1093294076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "736 MEDICAL CENTER DR STE 101",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284014284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "736 MEDICAL CENTER DR STE 101",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284014284",
            "telephone_number": "910-762-0255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACOB R. LONG, DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-09",
        "last_updated": "2018-08-09",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "910-762-0355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NC",
            "license": "10411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Naomi Namrota Jackson, PA-C
• P Brian Jackson, OD
• Rebecca Grace Jackson, MSW, LCSW
• Tiffany L Jackson, O.D.
• Woody H Jackson, MD
• Jacob's Business Ventures (A Loyal Home Care)
• Cheyanne Nevaeh Jacobs
• Lila G Jacobs
• Mariah Jacobs
• Shiletter Jacobs, CD

• Dental Clinic/Center in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Dental Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.