Keith M Long, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

40662 Issued in CA

Practice address

755 11TH St
Lakeport, CA 95453-3705

Phone

(707) 263-7023

Fax

(707) 263-6963

NPI assigned

Jan 11, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Stephanie Sandretti, DDS and Matthew Sandretti, DDS, MSD Inc

  • Dental Clinic/Center
  • Lakeport, CA
  • NPI 1518649516
  NPD (past)

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559606400000",
    "number": "1649320672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 11TH ST",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954533705",
            "telephone_number": "707-263-7023",
            "fax_number": "707-263-6963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 11TH ST",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954533705",
            "telephone_number": "707-263-7023",
            "fax_number": "707-263-6963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "KEITH",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2019-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "40662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Linnell, M.A.
• Stacy Litton
• Mark Stephen Loebs, MFT
• Conya Latish Lofton, RCP
• Henry Allen Long Jr., D.D.S.
• Longs Drug Stores California LLC
• Amy Lopez, LCSW
• Chloe Merae Lopez
• Reyna G Lopez
• Theresa Lopez

• Dentist in Lakeport, CA
• Providers in Lakeport, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2019; 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.