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General NPI Number Information
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NPI Number | 1598104242
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Entity Type | Organization
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Legal Business Name | POLARIS ORTHODONTIC CENTER AMIN MASON DDS, LLC
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Dates
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Enumeration Date | 06/17/2013
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 1079 POLARIS PKWY
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City | COLUMBUS
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State | OH
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Zip | 43240-2004
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Country | US
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Telephone | 614-781-6990
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Fax |
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Provider Business Mailing Address
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Address Line | 1079 POLARIS PKWY
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City | COLUMBUS
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State | OH
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Zip | 43240-2004
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Country | US
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Telephone | 614-781-6990
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Fax |
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Authorized Official
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Title or Position | OWNER/ORTHODONTIST
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Name | DR. AMIN MASON
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Credential | DDS
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Telephone | 614-563-4335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 30.023085
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License Number State | OH
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