Provider Demographics
NPI:1528440823
Name:MASON, VICKIE (RDH)
Entity type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:VICKIE
Other - Middle Name:
Other - Last Name:RUGGIERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:37 EPPING ST
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03077
Mailing Address - Country:US
Mailing Address - Phone:603-895-3161
Mailing Address - Fax:603-895-3993
Practice Address - Street 1:37 EPPING ST
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:NH
Practice Address - Zip Code:03077
Practice Address - Country:US
Practice Address - Phone:603-895-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2021124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist