Provider Demographics
NPI:1295967438
Name:MASON, MARIAN (DDS)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:
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 1:1580 SPRING GATE DR
Mailing Address - Street 2:UNIT # 4414
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3443
Mailing Address - Country:US
Mailing Address - Phone:703-728-1874
Mailing Address - Fax:
Practice Address - Street 1:5448 SAINT BARNABAS RD
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3622
Practice Address - Country:US
Practice Address - Phone:240-493-6030
Practice Address - Fax:240-493-7528
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1000362122300000X
MD13479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC089458024Medicaid
MD585076200Medicaid