Provider Demographics
NPI:1326398470
Name:GRANT S. MASON, DDS, INC.
Entity Type:Organization
Organization Name:GRANT S. MASON, DDS, INC.
Other - Org Name:MASON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:S
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-400-4835
Mailing Address - Street 1:3906 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1633
Mailing Address - Country:US
Mailing Address - Phone:304-400-4835
Mailing Address - Fax:681-205-8939
Practice Address - Street 1:3906 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1633
Practice Address - Country:US
Practice Address - Phone:304-400-4835
Practice Address - Fax:681-205-8939
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRANT S. MASON, DDS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3235261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center