Provider Demographics
NPI:1306333760
Name:ELKINS LONG, SHELLY (PHDHP)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:
Last Name:ELKINS LONG
Suffix:
Gender:F
Credentials:PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3826 JAVALYN CT
Mailing Address - Street 2:
Mailing Address - City:SLATINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18080-3822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3826 JAVALYN CT
Practice Address - Street 2:
Practice Address - City:SLATINGTON
Practice Address - State:PA
Practice Address - Zip Code:18080-3822
Practice Address - Country:US
Practice Address - Phone:610-657-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPHDHP000713124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPHDH000713OtherPA STATE BOARD OF DENTISTRY