Provider Demographics
NPI:1346412814
Name:MASON, JEFFREY ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
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 1:1087 BEACON STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1700
Mailing Address - Country:US
Mailing Address - Phone:617-965-8740
Mailing Address - Fax:
Practice Address - Street 1:1087 BEACON STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1700
Practice Address - Country:US
Practice Address - Phone:617-965-8740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16174122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist