Provider Demographics
NPI:1982676185
Name:MASSA, MARK A (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:MASSA
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 1:245 STERKEL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1500
Mailing Address - Country:US
Mailing Address - Phone:419-756-1452
Mailing Address - Fax:419-756-2560
Practice Address - Street 1:245 STERKEL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1500
Practice Address - Country:US
Practice Address - Phone:419-756-1452
Practice Address - Fax:419-756-2560
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH199081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice