Provider Demographics
NPI:1871691881
Name:MASI, ROBERT C (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:MASI
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 1:1017 LAKE SHORE RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48236-4104
Mailing Address - Country:US
Mailing Address - Phone:313-410-4509
Mailing Address - Fax:
Practice Address - Street 1:25630 LITTLE MACK AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2109
Practice Address - Country:US
Practice Address - Phone:586-285-5758
Practice Address - Fax:586-285-5410
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI155341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice