Provider Demographics
NPI:1215223979
Name:KONKLE, MASON BENSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MASON
Middle Name:BENSON
Last Name:KONKLE
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 1:7350 S MCCLINTOCK DR STE 103
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-5006
Mailing Address - Country:US
Mailing Address - Phone:480-838-3073
Mailing Address - Fax:480-838-5504
Practice Address - Street 1:7350 S MCCLINTOCK DR STE 103
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-5006
Practice Address - Country:US
Practice Address - Phone:480-838-3073
Practice Address - Fax:480-838-5504
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0082021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice