Provider Demographics
NPI:1609516749
Name:JONATHAN E MASON DMD PC
Entity Type:Organization
Organization Name:JONATHAN E MASON DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP RCM
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-749-8482
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VT
Mailing Address - Zip Code:05477-0043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:72 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VT
Practice Address - Zip Code:05477-4485
Practice Address - Country:US
Practice Address - Phone:802-434-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JONATHAN E MASON DMD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty