Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 23342 | CA |
NPI | 1104907195 |
---|---|
Provider Name | Dr. Dennis Glenn Longwill |
First Address | Ventura, CA 93003 |
Second Address | Ventura, CA 93003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |