Provider Demographics
NPI:1487835807
Name:MASON, PAMELLA OPAL (RDH)
Entity Type:Individual
Prefix:MS
First Name:PAMELLA
Middle Name:OPAL
Last Name:MASON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS NASSAU (LHA-4)
Mailing Address - Street 2:DENTAL
Mailing Address - City:FPO AE
Mailing Address - State:VA
Mailing Address - Zip Code:09557-1615
Mailing Address - Country:US
Mailing Address - Phone:757-445-6338
Mailing Address - Fax:
Practice Address - Street 1:1510 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23702-3121
Practice Address - Country:US
Practice Address - Phone:757-445-6338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402203737124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist