Healthcare Provider Details

I. General information

NPI: 1457331753
Provider Name (Legal Business Name): CHRISTPHER JOHN MASCIO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 MARILYN LN
NEW CUMBERLAND WV
26047-1510
US

IV. Provider business mailing address

140 STEUBENVILLE PIKE
BURGETTSTOWN PA
15021-8532
US

V. Phone/Fax

Practice location:
  • Phone: 304-797-1568
  • Fax:
Mailing address:
  • Phone: 724-729-4017
  • Fax: 724-729-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS-028798-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: