Provider Demographics
NPI:1841427002
Name:MASON, PATRICIA REXINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:REXINE
Last Name:MASON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:R HECK
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1205 EAGLE PASS WAY
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-8710
Mailing Address - Country:US
Mailing Address - Phone:256-831-7417
Mailing Address - Fax:256-831-7417
Practice Address - Street 1:1220 CHRISTINE AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4660
Practice Address - Country:US
Practice Address - Phone:256-237-0672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4242122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist