Provider Demographics
NPI:1407168297
Name:DELONG, SHEPARD J (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHEPARD
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 1:81 MAKAWAO AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8894
Mailing Address - Country:US
Mailing Address - Phone:808-547-4292
Mailing Address - Fax:808-585-0528
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2402
Practice Address - Country:US
Practice Address - Phone:808-547-4292
Practice Address - Fax:808-585-0528
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-2620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist