Individual
DR. KEITH A. MASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3907 S WESTNEDGE AVE, KALAMAZOO, MI 49008-3187
(269) 345-8893
(269) 492-1710
Mailing address
3907 S WESTNEDGE AVE, KALAMAZOO, MI 49008-3187
(269) 345-8893
(269) 492-1710
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901017761
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013074095
PRACTICE NPI #
MI
01
—
2901017761
STATE LICENSE #
MI
05
—
4172952
—
MI
01
—
486361
UNITED CONCORDIA PROVIDER
MI
Enumeration date
04/13/2007
Last updated
03/07/2023
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