Provider Demographics
NPI:1477859312
Name:MASSOUD, JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MASSOUD
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 1:1680 WESTWOOD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5105
Mailing Address - Country:US
Mailing Address - Phone:408-266-6811
Mailing Address - Fax:
Practice Address - Street 1:1670 WESTWOOD DR
Practice Address - Street 2:SUITE J
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5111
Practice Address - Country:US
Practice Address - Phone:408-266-6811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA601751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice