Provider Demographics
NPI:1316030885
Name:MASONBRINK, MONTE EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONTE
Middle Name:EDWARD
Last Name:MASONBRINK
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 1:1151 BETHEL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2775
Mailing Address - Country:US
Mailing Address - Phone:614-457-9337
Mailing Address - Fax:614-705-1867
Practice Address - Street 1:1161 BETHEL RD STE 303
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2773
Practice Address - Country:US
Practice Address - Phone:614-457-9337
Practice Address - Fax:614-705-1867
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0215941223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1033389382Medicare NSC
OHU79415Medicare UPIN