Provider Demographics
NPI:1386667418
Name:MASON, LORI ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:LORI
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 1:205 OAK PARK CIR
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50665-1062
Mailing Address - Country:US
Mailing Address - Phone:319-553-1189
Mailing Address - Fax:
Practice Address - Street 1:807 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:IA
Practice Address - Zip Code:50665-1023
Practice Address - Country:US
Practice Address - Phone:319-553-1193
Practice Address - Fax:319-553-1195
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0464107Medicaid