Provider Demographics
NPI:1013012848
Name:MASON, CHARLES W SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:MASON
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 BRUYER WAY
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-6305
Mailing Address - Country:US
Mailing Address - Phone:406-752-8686
Mailing Address - Fax:406-752-9473
Practice Address - Street 1:34 BRUYER WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-6305
Practice Address - Country:US
Practice Address - Phone:406-752-8686
Practice Address - Fax:406-752-9473
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT112866Medicaid