Provider Demographics
NPI:1376582635
Name:MASON, NORMAN LEWIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:LEWIS
Last Name:MASON
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 1:2113 E MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-1357
Mailing Address - Country:US
Mailing Address - Phone:512-477-9775
Mailing Address - Fax:512-477-4806
Practice Address - Street 1:2113 E MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-1357
Practice Address - Country:US
Practice Address - Phone:512-477-9775
Practice Address - Fax:512-477-4806
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice