Provider Demographics
NPI:1922092865
Name:DELONG, PAUL E (DMD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
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 1:100 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-7405
Mailing Address - Country:US
Mailing Address - Phone:563-557-1440
Mailing Address - Fax:563-557-7001
Practice Address - Street 1:100 BRYANT ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-7405
Practice Address - Country:US
Practice Address - Phone:563-557-1440
Practice Address - Fax:563-557-7001
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA060541223S0112X
WI32510151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07938OtherBCBS DELTA DENTAL
WI33653100Medicaid
IA0079384Medicaid
T00594Medicare UPIN
IA0079384Medicaid