Provider Demographics
NPI:1932317922
Name:MASON, JODI EVE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:EVE
Last Name:MASON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JODI
Other - Middle Name:EVE
Other - Last Name:FAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2008 RIVERSIDE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4443
Mailing Address - Country:US
Mailing Address - Phone:904-372-3260
Mailing Address - Fax:904-385-3704
Practice Address - Street 1:2008 RIVERSIDE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4443
Practice Address - Country:US
Practice Address - Phone:904-372-3260
Practice Address - Fax:904-385-3704
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN176581223P0221X, 1223P0221X
TX241221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282514301Medicaid
FL076760300Medicaid
TX282514301Medicaid