Provider Demographics
NPI:1649384058
Name:MASON, CHRISTINE M (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:MASON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 FOREST HILL AVE SE
Mailing Address - Street 2:STE #200
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7535
Mailing Address - Country:US
Mailing Address - Phone:616-949-0230
Mailing Address - Fax:616-949-1125
Practice Address - Street 1:2565 FOREST HILL AVE SE
Practice Address - Street 2:STE #200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7535
Practice Address - Country:US
Practice Address - Phone:616-949-0230
Practice Address - Fax:616-949-1125
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010181121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice