Provider Demographics
NPI:1548394976
Name:JAMES L. MAST, DDS, PC
Entity Type:Organization
Organization Name:JAMES L. MAST, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MAST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-774-2997
Mailing Address - Street 1:3011 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-3444
Mailing Address - Country:US
Mailing Address - Phone:928-774-2997
Mailing Address - Fax:928-556-9545
Practice Address - Street 1:3011 N WEST ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-3444
Practice Address - Country:US
Practice Address - Phone:928-774-2997
Practice Address - Fax:928-556-9545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty