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Individual

ADAM R LONG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
65-1230 MAMALAHOA HWY STE E21, KAMUELA, HI 96743-8319
(808) 887-8801
Mailing address
65-1230 MAMALAHOA HWY STE E21, KAMUELA, HI 96743-8319
(808) 887-8801

Taxonomy

Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
DT-2752
HI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DT-2752
STATE LICENSE
HI
Enumeration date
12/04/2018
Last updated
01/04/2024
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