MEDICARE: DR. MONTE EDWARD MASONBRINK D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	30.021594	OH

General Provider Information

NPI Number	:	1316030885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONTE EDWARD MASONBRINK D.D.S.

Provider Business Mailing Address
First Line	:	1151 BETHEL RD STE 104
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2775
Country	:	US
Telephone Number	:	614-457-9337
Fax Number	:	614-705-1867

Provider Business Practice Location Address
First Line	:	1161 BETHEL RD STE 303
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2773
Country	:	US
Telephone Number	:	614-457-9337
Fax Number	:	614-705-1867

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/22/2021

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Directions to “ DR. MONTE EDWARD MASONBRINK D.D.S.” Practice Location

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