Healthcare Provider Details

I. General information

NPI: 1306215025
Provider Name (Legal Business Name): MASON DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 LONGVIEW DRIVE
MANCHESTER VT
05254
US

IV. Provider business mailing address

PO BOX 317
MANCHESTER VT
05254-0317
US

V. Phone/Fax

Practice location:
  • Phone: 802-362-1099
  • Fax:
Mailing address:
  • Phone: 802-362-1099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN MASON
Title or Position: DMD
Credential:
Phone: 802-362-1099