MEDICARE: DR. STANLEY JOHN MASON DDS

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)	4128	VA

General Provider Information

NPI Number	:	1407867450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANLEY JOHN MASON DDS

Provider Business Mailing Address
First Line	:	3145 VIRGINIA BEACH BLVD STE 206
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-6950
Country	:	US
Telephone Number	:	757-340-9146
Fax Number	:	757-340-2647

Provider Business Practice Location Address
First Line	:	3145 VIRGINIA BEACH BLVD STE 206
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-6950
Country	:	US
Telephone Number	:	757-340-9146
Fax Number	:	757-340-2647

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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