Provider Demographics
NPI:1053492157
Name:LONGMAN, BRUCE IRVING (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:IRVING
Last Name:LONGMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 KEMPSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-2708
Mailing Address - Country:US
Mailing Address - Phone:757-495-4700
Mailing Address - Fax:757-495-3432
Practice Address - Street 1:855 KEMPSVILLE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-2708
Practice Address - Country:US
Practice Address - Phone:757-495-4700
Practice Address - Fax:757-495-3432
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010027821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT87201Medicare UPIN