Provider Demographics
NPI:1063552107
Name:MASSO, JOHN G (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:MASSO
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 1:2133 B BELCOURT AVE.
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-3503
Mailing Address - Country:US
Mailing Address - Phone:615-386-0029
Mailing Address - Fax:
Practice Address - Street 1:2133 B BELCOURT AVE.
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3503
Practice Address - Country:US
Practice Address - Phone:615-386-0029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN75801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice