Provider Demographics
NPI:1548748635
Name:MASON DENTAL HYGIENE GROUP
Entity Type:Organization
Organization Name:MASON DENTAL HYGIENE GROUP
Other - Org Name:MASON DENTAL HYGIENE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:602-299-0584
Mailing Address - Street 1:30168 POINT MARINA DR
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-7411
Mailing Address - Country:US
Mailing Address - Phone:602-299-0584
Mailing Address - Fax:
Practice Address - Street 1:30168 POINT MARINA DR
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-7411
Practice Address - Country:US
Practice Address - Phone:602-299-0584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP622124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty