Provider Demographics
NPI:1104072867
Name:MASSON, JORDAN THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:THOMAS
Last Name:MASSON
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 1:2533 SHIPS WATCH CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1269
Mailing Address - Country:US
Mailing Address - Phone:248-410-0999
Mailing Address - Fax:
Practice Address - Street 1:242 MUSTANG TRL
Practice Address - Street 2:SUITE #9
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7515
Practice Address - Country:US
Practice Address - Phone:757-340-1153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412245122300000X
MI2901019784122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist