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1437871076 NPI number — TREVOR TAREK MASON DMD

NPI Number: 1437871076
Health Care Provider/Practitioner: TREVOR TAREK MASON DMD

Information about “1437871076” NPI (TREVOR TAREK MASON DMD) exists in 1437871076 in HTML format HTML  |  1437871076 in plain Text format TXT  |  1437871076 in PDF (Portable Document Format) PDF  |  1437871076 in an XML format XML  formats.

NPI Number : 1437871076 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1437871076",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MASON",
    "FirstName": "TREVOR",
    "MiddleName": "TAREK",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "55 LEWIS ST APT 612",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EAST BOSTON",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "02128-2672",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "806-543-8107",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "60 LEO M BIRMINGHAM PKWY STE 201",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BRIGHTON",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "02135-1155",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "617-783-1822",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/12/2022",
    "LastUpdateDate": "04/20/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "04/11/2023",
    "NPIReactivationDate": "04/20/2023",
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223G0001X",
        "TaxonomyName": "General Practice Dentistry",
        "LicenseNumber": "DN1859636",
        "LicenseNumberStateCode": "MA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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