Provider Demographics
NPI:1700052255
Name:MASON DENTAL CENTER PA
Entity Type:Organization
Organization Name:MASON DENTAL CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-822-4664
Mailing Address - Street 1:4455 HARRY WURZBACH RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2402
Mailing Address - Country:US
Mailing Address - Phone:210-822-4664
Mailing Address - Fax:210-822-4878
Practice Address - Street 1:4455 HARRY WURZBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2402
Practice Address - Country:US
Practice Address - Phone:210-822-4664
Practice Address - Fax:210-422-4878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty