Provider Demographics
NPI:1790787240
Name:MASON, BRIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
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 1:1422 CIRCLEVILLE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-2269
Mailing Address - Country:US
Mailing Address - Phone:740-474-6900
Mailing Address - Fax:740-474-6911
Practice Address - Street 1:1422 CIRCLEVILLE PLAZA DR
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-2269
Practice Address - Country:US
Practice Address - Phone:740-474-6900
Practice Address - Fax:740-474-6911
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300217631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2429803Medicaid