Provider Demographics
NPI:1053520460
Name:LONG, BETSY ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:BETSY
Middle Name:ANN
Last Name:LONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:BETSY
Other - Middle Name:ANN
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:526 VINE ST
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN DELLS
Mailing Address - State:WI
Mailing Address - Zip Code:53965-1830
Mailing Address - Country:US
Mailing Address - Phone:608-678-3010
Mailing Address - Fax:
Practice Address - Street 1:526 VINE ST
Practice Address - Street 2:
Practice Address - City:WISCONSIN DELLS
Practice Address - State:WI
Practice Address - Zip Code:53965-1830
Practice Address - Country:US
Practice Address - Phone:608-678-3010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6132-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice