Active NPI
Evan G Long, DDS
- Pediatric Dentistry
- Concord, NC
National Provider Identifier
1992719587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 6693
- Practice address
- 5641 Poplar Tent Rd
Suite 201
Concord, NC 28027-7533 - Phone
- (704) 795-2300
- Fax
- (704) 795-2301
- NPI assigned
- Jul 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 6693 | NC | Primary |
Addresses
Primary practice location
5641 Poplar Tent Rd
Suite 201
Concord, NC 28027-7533
Mailing address
5641 Poplar Tent Rd
Suite 201
Concord, NC 28027-7533
Phone (704) 795-2300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 799002-T | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6693 | NC | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992719587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5641 POPLAR TENT RD",
"address_2": "SUITE 201",
"city": "CONCORD",
"state": "NC",
"postal_code": "280277533",
"telephone_number": "704-795-2300",
"fax_number": "704-795-2301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5641 POPLAR TENT RD",
"address_2": "SUITE 201",
"city": "CONCORD",
"state": "NC",
"postal_code": "280277533",
"telephone_number": "704-795-2300",
"fax_number": "704-795-2301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONG",
"first_name": "EVAN",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NC",
"license": "6693",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "799002-T",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Concord, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.