Provider Demographics
NPI:1417335258
Name:DEARING, MASON ANDREW (DDS, MS)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:ANDREW
Last Name:DEARING
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3719
Mailing Address - Country:US
Mailing Address - Phone:580-357-4946
Mailing Address - Fax:
Practice Address - Street 1:814 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3719
Practice Address - Country:US
Practice Address - Phone:580-357-4946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK66931223X0400X
IARES-30446390200000X
OK2201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program