1558360974 NPI number — LONG ,LAXER & SAVAGE DDS, PLLC

Table of content: (NPI 1558360974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558360974 NPI number — LONG ,LAXER & SAVAGE DDS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONG ,LAXER & SAVAGE DDS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558360974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7820 BALLANTYNE COMMONS PKWY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28277-2841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-759-0000
Provider Business Mailing Address Fax Number:
704-759-9937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7820 BALLANTYNE COMMONS PKWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28277-2841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-759-0000
Provider Business Practice Location Address Fax Number:
704-759-9937
Provider Enumeration Date:
07/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LONG
Authorized Official First Name:
LINWOOD
Authorized Official Middle Name:
MARVIN
Authorized Official Title or Position:
DENTIST / ORTHODONTIST
Authorized Official Telephone Number:
704-759-0000

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  0138 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223X0400X , with the licence number: 0138 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 148760706 . This is a "DR. LONG'S ADA#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89902XA , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8995372 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9016K . This is a "DR. LAXER'S BCBS#" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 902XA . This is a "DR. SAVAGE'S BCBS#" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 899016K , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95372 . This is a "DR. LONG'S BCBS#" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 143881557 . This is a "DR. LAXER'S ADA#" identifier . This identifiers is of the category "OTHER".




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