Provider Demographics
NPI:1508078536
Name:MASON, THOMAS HARRELL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HARRELL
Last Name:MASON
Suffix:JR
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 1:1621 PASS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4341
Mailing Address - Country:US
Mailing Address - Phone:228-436-4401
Mailing Address - Fax:228-436-4663
Practice Address - Street 1:1621 PASS RD
Practice Address - Street 2:SUITE C
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4341
Practice Address - Country:US
Practice Address - Phone:228-436-4401
Practice Address - Fax:228-436-4663
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1806-781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice