DR. LARRY KEITH LONG (NPI# 1275527137) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275527137 |
| Entity Type | Individual |
| Full Name | DR. LARRY KEITH LONG |
| Credential | DDS,MD |
| Practice Address |
2624 Jenks Ave Ste 1 Panama City FL 32405 |
| Mailing Address |
2624 Jenks Ave Ste 1 Panama City FL 32405-4311 |
| Practice Telephone | 2106675171 |
| Mailing Telephone | 2106675171 |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2019-05-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DN23806 | FL | Dental Providers |
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
6538 | NC | Dental Providers |
| N | 204E00000X | Oral & Maxillofacial Surgery | DN23806 | FL | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2200 Bergquist Dr, Suite 1, Lackland A F B, TX 782369907 | 2105545215 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003096546 | Larry Stuart Long | Pharmacist | 3105 Love Ct, Gastonia, NC 28056-8869 | 2007-11-13 |
| 1053530873 | Larry I Long | Dentist | 7029 Vista Dr, West Des Moines, IA 50266-9311 | 2007-04-24 |
| 1184736878 | Larry D Long | Dentist | 102 North Fourth Street, Youngwood, PA 15697-1383 | 2006-08-31 |
| 1720040652 | Larry Long | Physician Assistant | 9305 Pinecroft Dr, Suite 101, The Woodlands, TX 77380-3482 | 2006-04-05 |
| 1346313061 | Larry Eugene Long Jr. | Psychologist | 8080 Ward Pkwy, Suite 330, Kansas City, MO 64114-2034 | 2006-11-17 |
| Street Address |
2624 JENKS AVE STE 1 |
| City | PANAMA CITY |
| State | FL |
| Zip Code | 32405 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457962136 | Kimberlea Fox | Behavioral Analyst | 4750 Collegiate Drive, Technology Building 157, Panama City, FL 32405 | 2020-08-14 |
| 1598325714 | Covenant Home Health Care, LLC | Home Health | 107 W. 19th Street, Panama City, FL 32405 | 2019-06-19 |
| 1467921403 | Amy Hancock | Counselor | 1212 W. 19th St., Panama City, FL 32405 | 2018-11-20 |
| 1063991917 | Patricia Kagendo Mutunga | Day Training, Developmentally Disabled Services | 2813 Fairmont Dr, Panama City, FL 32405 | 2018-08-11 |
| 1871087882 | Southeastern Dermatology Group Pa | Pharmacy | 2505 Harrison Ave Ste A, Panama City, FL 32405 | 2018-06-22 |
| 1346733615 | Jessica Nicole Graham | Nurse Practitioner | 2507 Harrison Ave Unit 101, Panama City, FL 32405 | 2018-06-12 |
| 1437658424 | Coastal Mobility Transportation, LLC | Non-emergency Medical Transport (VAN) | 203 Forest Park Circle, Panama City, FL 32405 | 2018-02-06 |
| 1003314915 | The Anti-aging Clinic of Northwest Florida | Obstetrics & Gynecology | 3019 Osprey Cir, Panama City, FL 32405 | 2018-01-25 |
| 1255848487 | Sarah Theriot | Social Worker | 700 W 23rd St Bldg H, Panama City, FL 32405 | 2018-01-09 |
| 1336686054 | Angela Leake | Registered Nurse | 449 W 23 St, Panama City, FL 32405 | 2017-01-20 |
| Find all providers in zip 32405 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194983965 | Eric Richard Claussen | Dentist | 2624 Jenks Ave, Panama City, FL 32405-4311 | 2008-05-29 |
| 1790087138 | Eric R. Claussen, D.m.d., P.a. | Dentist | 2624 Jenks Ave, Panama City, FL 32405-4311 | 2010-11-17 |
| 1477714384 | Gregory P Grantham Dmd Pa | Dentist | 340 W 23rd St, Suite A, Panama City, FL 32405-7600 | 2008-06-23 |
| 1053462044 | Gregory Porter Grantham | Dentist | 340 W 23rd St, Suite A, Panama City, FL 32405-7600 | 2007-01-16 |
| 1477538924 | George John Walters | Dentist | 2202 State Ave, Suite 200, Panama City, FL 32405-7601 | 2005-12-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346862786 | Mikhail Daya Dmd Pa | Dentist | 500 Knights Run Ave Unit 1714, Tampa, FL 33602-6017 | 2020-05-08 |
| 1578114443 | South Florida Jaw and Facial Surgery-dental Implants Center Pa | Dentist | 7600 S Red Rd Ste 101, South Miami, FL 33143-5429 | 2019-09-23 |
| 1437703535 | Ambiance Surgical Arts Center | Dentist | 8501 Sw 124th Ave Ste 208, Miami, FL 33183-4633 | 2019-07-26 |
| 1053979997 | Anand R Patel | Dentist | 1395 Center Dr # D1-56a, Gainesville, FL 32610-3006 | 2019-06-05 |
| 1801353792 | Oral Maxillofacial and Implant Specialists, LLC | Dentist | 4675 Van Dyke Rd., Lutz, FL 33558 | 2019-02-27 |
| 1952871030 | Harvey Mossak Oral & Maxillofacial Surgery, Pllc | Dentist | 1211 E Kennedy Blvd Unit 223, Tampa, FL 33602-3559 | 2018-11-30 |
| 1093283582 | Keith H. Kaner, Dds, Pa | Dentist | 9250 Glades Rd Ste 207, Boca Raton, FL 33434-3958 | 2018-11-02 |
| 1750858015 | Hebah Omar Aljuhani | Dentist | 253 Ne 2nd St Apt 613, Miami, FL 33132-2289 | 2018-10-25 |
| 1972089431 | Plantation Dental and Anesthesia Associates | Dentist | 300 Nw 70th Ave Ste 104, Plantation, FL 33317-2360 | 2018-07-17 |
| 1871079921 | Paul Amailuk | Dentist | 9333 Sw 152nd Street, Oral and Maxillofacial Surgery Department, Miami, FL 33157 | 2018-07-12 |
| Find all providers with the same taxonomy | ||||
| City | PANAMA CITY |
| Zip Code | 32405 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.