Provider Demographics
NPI:1174493142
Name:LUCAS, MASON JOHN
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:JOHN
Last Name:LUCAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4070 STANLEY RD STE 401
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78234-2714
Mailing Address - Country:US
Mailing Address - Phone:406-475-5168
Mailing Address - Fax:
Practice Address - Street 1:4070 STANLEY RD STE 401
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-2714
Practice Address - Country:US
Practice Address - Phone:406-475-5168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-06
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist