Provider Demographics
NPI:1851655575
Name:MASON, ANDREA MARIE (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MARIE
Last Name:MASON
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4528 MAPLE LN SE # 201
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-8638
Mailing Address - Country:US
Mailing Address - Phone:360-352-3515
Mailing Address - Fax:360-352-0158
Practice Address - Street 1:4528 MAPLE LN SE # 201
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-8638
Practice Address - Country:US
Practice Address - Phone:360-352-3515
Practice Address - Fax:360-352-0158
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602847241223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1053654525Medicaid