Provider Demographics
NPI:1154498426
Name:MASTON, PAUL RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RICHARD
Last Name:MASTON
Suffix:
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 1:1622 W MILHAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1230
Mailing Address - Country:US
Mailing Address - Phone:269-381-0564
Mailing Address - Fax:269-343-8479
Practice Address - Street 1:1622 W MILHAM AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1230
Practice Address - Country:US
Practice Address - Phone:269-343-8378
Practice Address - Fax:269-343-8479
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901009951122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist