MEDICARE: JOHN R 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	1223G0001X	General Practice Dentistry	2410	ME

General Provider Information

NPI Number	:	1508976622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN R MASON DDS

Provider Business Mailing Address
First Line	:	PO BOX 570
Second Line	:
City	:	BETHEL
State	:	ME
Zip	:	04217-0570
Country	:	US
Telephone Number	:	207-824-3378
Fax Number	:	207-824-3012

Provider Business Practice Location Address
First Line	:	44 NORTH RD
Second Line	:
City	:	BETHEL
State	:	ME
Zip	:	04217-0570
Country	:	US
Telephone Number	:	207-824-3378
Fax Number	:	207-824-3012

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Directions to “ JOHN R MASON DDS” Practice Location

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