Robert Earl Long Sr., DDS

Primary specialty

DentistTaxonomy code 122300000X

License

186980 Issued in MS

Practice address

527 Desoto Ave
Clarksdale, MS 38614-5216

Phone

(662) 627-2565

Fax

(662) 627-2524

NPI assigned

Dec 17, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Long Family Dentistry Inc

  • Dentist
  • Clarksdale, MS
  • NPI 1811050313
  NPD (past) Authorized official

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

{
    "created_epoch": "1197849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197849600000",
    "number": "1437332160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 DESOTO AVE",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386145216",
            "telephone_number": "662-627-2565",
            "fax_number": "662-627-2524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "527 DESOTO AVE",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386145216",
            "telephone_number": "662-627-2565",
            "fax_number": "662-627-2524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "ROBERT",
        "middle_name": "EARL",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-17",
        "last_updated": "2007-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "186980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00064885",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeanne Mariah Lilly, PHD
• Lion Hospice & Palliative Care, LLC
• Kolby Nicole Little, MED, LPC, NCC
• Lillie Mae Lockett
• Long Family Dentistry Inc
• Shirley Long, M.ED.
• Dalisa Lusby
• James W Major, M.D.
• Carole L Mangrem, M.D.
• Chitra S. Mani, MD

• Dentist in Clarksdale, MS
• Providers in Clarksdale, MS by specialty
• Dentist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; 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.