Healthcare Provider Details

I. General information

NPI: 1407867450
Provider Name (Legal Business Name): STANLEY JOHN MASON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 VIRGINIA BEACH BLVD STE 206
VIRGINIA BEACH VA
23452-6950
US

IV. Provider business mailing address

3145 VIRGINIA BEACH BLVD STE 206
VIRGINIA BEACH VA
23452-6950
US

V. Phone/Fax

Practice location:
  • Phone: 757-340-9146
  • Fax: 757-340-2647
Mailing address:
  • Phone: 757-340-9146
  • Fax: 757-340-2647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4128
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: