Dr Shawn R Long DDS PC

Primary specialty

DentistTaxonomy code 122300000X

License

12009672 Issued in IN

Legal business name

DR SHAWN R LONG DDS PC

Practice address

16329 State Rd 23
South Bend, IN 46635

Phone

(574) 243-8843

Fax

(574) 243-8845

NPI assigned

Nov 16, 2006

Organization subpart

No

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

Authorized official

Name

Patricia L Long

Title

Partner

Phone

(574) 243-8843

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shawn Ray Long, DDS

  • Dentist
  • South Bend, IN
  • NPI 1194892778
  NPD (past)

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1346313236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16329 STATE RD 23",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "46635",
            "telephone_number": "574-243-8843",
            "fax_number": "574-243-8845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16329 STATE RD 23",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "46635",
            "telephone_number": "574-243-8843",
            "fax_number": "574-243-8845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR SHAWN R LONG DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "574-243-8843"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12009672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in South Bend, IN
• Providers in South Bend, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.