=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306905583
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOUGLAS M MASI DMD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 64 E SOMERSET ST
-----------------------------------------------------
City | RARITAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08869-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-725-1525
-----------------------------------------------------
Fax | 908-725-4890
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 64 E SOMERSET ST
-----------------------------------------------------
City | RARITAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08869-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-725-1525
-----------------------------------------------------
Fax | 908-725-4890
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST OWNER
-----------------------------------------------------
Name | DR. DOUGLAS MORRISON MASI
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 908-725-1525
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------