Provider Demographics
NPI:1669652764
Name:MASON, BRUCE ALLAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALLAN
Last Name:MASON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 POPLAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:TURNER
Mailing Address - State:ME
Mailing Address - Zip Code:04282-0220
Mailing Address - Country:US
Mailing Address - Phone:207-225-2281
Mailing Address - Fax:
Practice Address - Street 1:139 POPLAR HILL RD
Practice Address - Street 2:
Practice Address - City:TURNER
Practice Address - State:ME
Practice Address - Zip Code:04282-3828
Practice Address - Country:US
Practice Address - Phone:207-225-2281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME23061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery