Provider Demographics
NPI:1568510329
Name:YEARY, MASON BRADLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MASON
Middle Name:BRADLEY
Last Name:YEARY
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 1:1312 VILLAGE CREEK DR
Mailing Address - Street 2:#1100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4467
Mailing Address - Country:US
Mailing Address - Phone:972-231-7216
Mailing Address - Fax:972-234-0390
Practice Address - Street 1:1312 VILLAGE CREEK DR
Practice Address - Street 2:#1100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4467
Practice Address - Country:US
Practice Address - Phone:972-231-7216
Practice Address - Fax:972-234-0390
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice