Provider Demographics
NPI:1598893976
Name:MASON, LOUIS L (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:L
Last Name:MASON
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 1:260 S ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767
Mailing Address - Country:US
Mailing Address - Phone:225-346-1776
Mailing Address - Fax:225-706-1567
Practice Address - Street 1:260 S ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-3016
Practice Address - Country:US
Practice Address - Phone:225-346-1776
Practice Address - Fax:225-706-1567
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA35011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice