Provider Demographics
NPI:1083848964
Name:MASSARO, MARY JOSEPHINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JOSEPHINE
Last Name:MASSARO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 LEWIS RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3404
Mailing Address - Country:US
Mailing Address - Phone:484-557-4475
Mailing Address - Fax:
Practice Address - Street 1:3413 LEWIS RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3404
Practice Address - Country:US
Practice Address - Phone:484-557-4475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0380571223G0001X
DEG100012911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice