Healthcare Provider Details

I. General information

NPI: 1114133089
Provider Name (Legal Business Name): JOHN R. MASON, D.D.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 NORTH RD
BETHEL ME
04217
US

IV. Provider business mailing address

PO BOX 570
BETHEL ME
04217-0570
US

V. Phone/Fax

Practice location:
  • Phone: 207-824-3378
  • Fax: 207-824-3012
Mailing address:
  • Phone: 207-824-3378
  • Fax: 207-824-3012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2410
License Number StateME

VIII. Authorized Official

Name: DR. JOHN R MASON
Title or Position: OWNER
Credential: D.D.S.
Phone: 207-824-3378