Ethan Long DDS PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ETHAN LONG DDS PLLC

Practice address

1105 E Lamar Alexander Pkwy
Maryville, TN 37804-5130

Phone

(865) 984-7757

Fax

(865) 724-2272

NPI assigned

Sep 7, 2023

Organization subpart

No

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

Authorized official

Name

Janet Latham

Title

Office Manager

Phone

(865) 984-7757

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ethan Michael Long, DDS

  • Dentist
  • Kodak, TN
  • NPI 1144679523
  NPD
• Alfred Louis Redwine, D.D.S.

  • Dentist
  • Maryville, TN
  • NPI 1811966559
  NPD (past)
• Sarah-Wallace Riemer, DMD

  • General Practice Dentistry
  • Maryville, TN
  • NPI 1699692434
  NPD (past)

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

{
    "created_epoch": "1694044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1376329094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 E LAMAR ALEXANDER PKWY",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378045130",
            "telephone_number": "865-984-7757",
            "fax_number": "865-724-2272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 E LAMAR ALEXANDER PKWY",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378045130",
            "telephone_number": "865-984-7757",
            "fax_number": "865-724-2272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHAN LONG DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-07",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A",
        "authorized_official_last_name": "LATHAM",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "865-984-7757"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Envision Family Eyecare, PLLC
• Lauren Ashley Erdman
• Eric Anderson PA (Anderson Chiropractic Clinic)
• Ashley Danielle Eslinger, COTA/L
• Nicholas Estep
• Brock D. Evans, DMD
• Mark D Evans, DDS
• Samuel Dixie Evans, M.D.
• Morgan Everett
• Shannon Everett, NP-C

• General Practice Dentistry in Maryville, TN
• Providers in Maryville, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; 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.