Provider Demographics
NPI:1144470626
Name:DIAMOND, MASON W (DDS)
Entity type:Individual
Prefix:DR
First Name:MASON
Middle Name:W
Last Name:DIAMOND
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 1:150 LEVINBERG LN
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4062
Mailing Address - Country:US
Mailing Address - Phone:973-305-0213
Mailing Address - Fax:
Practice Address - Street 1:855 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3611
Practice Address - Country:US
Practice Address - Phone:973-373-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01437600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty