Provider Demographics
NPI:1437686862
Name:MASI, JOHN HENRY (DMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:MASI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S 16TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1645
Mailing Address - Country:US
Mailing Address - Phone:856-313-6637
Mailing Address - Fax:
Practice Address - Street 1:909 WALNUT ST RM 300
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5211
Practice Address - Country:US
Practice Address - Phone:215-503-7118
Practice Address - Fax:215-923-9189
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0412931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery