Provider Demographics
NPI:1598780108
Name:DELONG, KURT J (DMD)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:J
Last Name:DELONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 VICTOR POINT RD NE
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-9573
Mailing Address - Country:US
Mailing Address - Phone:503-873-5086
Mailing Address - Fax:503-873-6020
Practice Address - Street 1:303 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1605
Practice Address - Country:US
Practice Address - Phone:503-873-8614
Practice Address - Fax:503-873-6020
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR55231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice