Provider Demographics
NPI:1447479100
Name:HADDOW, MASON (DDS)
Entity type:Individual
Prefix:DR
First Name:MASON
Middle Name:
Last Name:HADDOW
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 1:28625 SOUTHFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076
Mailing Address - Country:US
Mailing Address - Phone:248-569-2056
Mailing Address - Fax:248-569-8987
Practice Address - Street 1:28625 SOUTHFIELD ROAD
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076
Practice Address - Country:US
Practice Address - Phone:248-569-2056
Practice Address - Fax:248-569-8987
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI148011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics