Provider Demographics
NPI:1104035013
Name:MASON, ROBERT REILLY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:REILLY
Last Name:MASON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 BERGEN BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-2032
Mailing Address - Country:US
Mailing Address - Phone:201-941-4777
Mailing Address - Fax:201-941-9791
Practice Address - Street 1:579 BERGEN BLVD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-2032
Practice Address - Country:US
Practice Address - Phone:201-941-4777
Practice Address - Fax:201-941-9791
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI011886001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice