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General NPI Number Information
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NPI Number | 1548748635
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Entity Type | Organization
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Legal Business Name | MASON DENTAL HYGIENE GROUP
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Dates
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Enumeration Date | 08/01/2018
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 30168 POINT MARINA DR
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City | CANYON LAKE
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State | CA
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Zip | 92587-7411
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Country | US
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Telephone | 602-299-0584
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Fax |
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Provider Business Mailing Address
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Address Line | 30168 POINT MARINA DR
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City | CANYON LAKE
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State | CA
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Zip | 92587-7411
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Country | US
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Telephone | 602-299-0584
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMY LYNN MASON
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Credential | RDHAP
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Telephone | 602-299-0584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | HAP622
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License Number State | CA
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