Provider Demographics
NPI:1255957445
Name:MASON, OLIVIA ANN (DDS)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ANN
Last Name:MASON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BORDER LN
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-7182
Mailing Address - Country:US
Mailing Address - Phone:304-238-8680
Mailing Address - Fax:
Practice Address - Street 1:1512 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:WELLSBURG
Practice Address - State:WV
Practice Address - Zip Code:26070-1323
Practice Address - Country:US
Practice Address - Phone:304-238-8680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV44711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice