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Individual

DR. BRUCE E. MASON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
117 N LAFAYETTE ST, MOUNT PULASKI, IL 62548-1263
(217) 792-5060
Mailing address
117 N LAFAYETTE ST, MOUNT PULASKI, IL 62548-1263
(217) 792-5060

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1002867
IL
Enumeration date
01/26/2007
Last updated
07/08/2007
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