Jerrod D. Long, D.D.S.

Key facts

NPI

1356493829

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

License

5037 (AZ)

Practice address

#2 Naco Road
Bisbee, AZ 85603-2898

Phone

(520) 432-5370

Fax

(520) 432-6658

NPI assigned

Jan 17, 2007

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356493829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "#2 NACO ROAD",
            "address_2": "BOX 1898",
            "city": "BISBEE",
            "state": "AZ",
            "postal_code": "856032898",
            "telephone_number": "520-432-5371",
            "fax_number": "520-432-6658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "#2 NACO ROAD",
            "city": "BISBEE",
            "state": "AZ",
            "postal_code": "856032898",
            "telephone_number": "520-432-5370",
            "fax_number": "520-432-6658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "JERROD",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "5037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Bisbee, AZ · General Practice Dentistry in Arizona