Provider Demographics
NPI:1710391222
Name:MASON, LINDSEY (DMD)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PULASKI
Mailing Address - State:IL
Mailing Address - Zip Code:62548-1263
Mailing Address - Country:US
Mailing Address - Phone:217-792-5060
Mailing Address - Fax:
Practice Address - Street 1:117 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:MOUNT PULASKI
Practice Address - State:IL
Practice Address - Zip Code:62548-1263
Practice Address - Country:US
Practice Address - Phone:217-792-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist