Provider Demographics
NPI:1952142796
Name:PRESLEY, MASON LEE GARDELLA (DMD)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:LEE GARDELLA
Last Name:PRESLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MASON
Other - Middle Name:LEE
Other - Last Name:GARDELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 CAGAN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-6405
Mailing Address - Country:US
Mailing Address - Phone:407-905-8827
Mailing Address - Fax:407-660-1667
Practice Address - Street 1:509 CAGAN VIEW RD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-6405
Practice Address - Country:US
Practice Address - Phone:074-905-8827
Practice Address - Fax:407-660-1667
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29008122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice