Provider Demographics
NPI:1245212323
Name:MASON O MINER DDS LLC
Entity Type:Organization
Organization Name:MASON O MINER DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-247-2677
Mailing Address - Street 1:72 SUTTLE ST
Mailing Address - Street 2:STE H
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303
Mailing Address - Country:US
Mailing Address - Phone:970-247-2677
Mailing Address - Fax:970-382-9581
Practice Address - Street 1:72 SUTTLE ST
Practice Address - Street 2:STE H
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303
Practice Address - Country:US
Practice Address - Phone:970-247-2677
Practice Address - Fax:970-382-9581
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MASON O MINER DDS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-15
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8689122300000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No122300000XDental ProvidersDentistGroup - Multi-Specialty