Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 1941 | MT |
NPI | 1013012848 |
---|---|
Provider Name | Dr. Charles W Mason SR. |
First Address | Kalispell, MT 59901-6305 |
Second Address | Kalispell, MT 59901-6305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 12/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
112866 | (05) | MT |