Provider Demographics
NPI:1992275861
Name:LONG, ADAM R (DMD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:R
Last Name:LONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:65-1230 MAMALAHOA HWY STE E21
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8319
Mailing Address - Country:US
Mailing Address - Phone:808-887-8801
Mailing Address - Fax:
Practice Address - Street 1:65-1230 MAMALAHOA HWY STE E21
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8319
Practice Address - Country:US
Practice Address - Phone:808-887-8801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIDT-27521223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIDT-2752OtherSTATE LICENSE