Provider Demographics
NPI:1871247502
Name:MASON R DAVIS DDS PLC
Entity Type:Organization
Organization Name:MASON R DAVIS DDS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MASON
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-822-0580
Mailing Address - Street 1:1623 S PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-6203
Mailing Address - Country:US
Mailing Address - Phone:918-585-2254
Mailing Address - Fax:918-583-8765
Practice Address - Street 1:1623 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-6203
Practice Address - Country:US
Practice Address - Phone:918-585-2254
Practice Address - Fax:918-583-8765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental