Provider Demographics
NPI:1811367576
Name:MASON, SHARON
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BAXTER RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7032
Mailing Address - Country:US
Mailing Address - Phone:636-227-2237
Mailing Address - Fax:
Practice Address - Street 1:510 BAXTER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-7032
Practice Address - Country:US
Practice Address - Phone:636-227-2237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0156821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1710072882OtherNPI