Provider Demographics
NPI:1396814638
Name:BURGESS AND MASON DDS
Entity Type:Organization
Organization Name:BURGESS AND MASON DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERPARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-481-4717
Mailing Address - Street 1:1105 W WALL ST
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5152
Mailing Address - Country:US
Mailing Address - Phone:817-481-4717
Mailing Address - Fax:817-488-8335
Practice Address - Street 1:1105 W WALL ST
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5152
Practice Address - Country:US
Practice Address - Phone:817-481-4717
Practice Address - Fax:817-488-8335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172111223G0001X
TX90321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty