Provider Demographics
NPI:1083829147
Name:SCOTT MASON DDS
Entity Type:Organization
Organization Name:SCOTT MASON DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:POPRIETOR, OWNER, OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:C
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-683-3636
Mailing Address - Street 1:132 W WASHINGTON
Mailing Address - Street 2:PO BOX 1058
Mailing Address - City:AVA
Mailing Address - State:MO
Mailing Address - Zip Code:65608
Mailing Address - Country:US
Mailing Address - Phone:417-683-3636
Mailing Address - Fax:417-683-6118
Practice Address - Street 1:132 W WASHINGTON
Practice Address - Street 2:BOX 1058
Practice Address - City:AVA
Practice Address - State:MO
Practice Address - Zip Code:65608
Practice Address - Country:US
Practice Address - Phone:417-683-3636
Practice Address - Fax:417-683-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO013438122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty