Provider Demographics
NPI:1598837155
Name:MASON, MARY ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:MASON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 PARKMOOR CT
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-4385
Mailing Address - Country:US
Mailing Address - Phone:251-639-9621
Mailing Address - Fax:
Practice Address - Street 1:5011 GOVERNMENT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-5029
Practice Address - Country:US
Practice Address - Phone:251-661-3420
Practice Address - Fax:251-661-3430
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1519096OtherUNITED CONCORDIA
AL51501638OtherBCBS OF AL
AL379328OtherBCBS OF KANSAS