Provider Demographics
NPI:1245871326
Name:BISHOP, MASON (DDS)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:
Last Name:BISHOP
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 1:322 TURNPIKE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-1378
Mailing Address - Country:US
Mailing Address - Phone:304-619-6305
Mailing Address - Fax:
Practice Address - Street 1:402 RED OAK ST
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1000
Practice Address - Country:US
Practice Address - Phone:304-872-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV44091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice