Patrick W Long, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

17545 Issued in OH

Practice address

3775 Central Ave
Shadyside, OH 43947

Phone

(740) 676-2604

Fax

(740) 676-8714

NPI assigned

Oct 5, 2006

Last updated

Aug 8, 2012By the provider in NPPES

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Complete Dental Care of Shadyside

  • Dentist
  • Shadyside, OH
  • NPI 1609323831
  NPD (past)
• Professional Dental Alliance of Shadyside, LLC

  • Dentist
  • Shadyside, OH
  • NPI 1124589585
  NPD (past)

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344384000000",
    "number": "1932295797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 147",
            "city": "SHADYSIDE",
            "state": "OH",
            "postal_code": "439470147",
            "telephone_number": "740-676-2604",
            "fax_number": "740-676-8714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3775 CENTRAL AVE",
            "city": "SHADYSIDE",
            "state": "OH",
            "postal_code": "43947",
            "telephone_number": "740-676-2604",
            "fax_number": "740-676-8714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "PATRICK",
        "middle_name": "W",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2012-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "17545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0579066",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sherry Howell
• Shawn Howland
• Innovative Work Solutions, LLC
• Alexa King, CF-SLP
• Kelsey Knight
• Natalie Marie Martin
• Mead Township Trustees (Mead Township-Shadyside Fire Department)
• Sheryl Lynn Miller, NP-C
• Chevy Lee Minney
• Stephanie Mulvey, LMT

• Dentist in Shadyside, OH
• Providers in Shadyside, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2012; 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.