Provider Demographics
NPI:1932327087
Name:ROBERT L. MASON DDS PA
Entity Type:Organization
Organization Name:ROBERT L. MASON DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-879-2622
Mailing Address - Street 1:101 S MCGEE ST
Mailing Address - Street 2:
Mailing Address - City:CANEY
Mailing Address - State:KS
Mailing Address - Zip Code:67333-2140
Mailing Address - Country:US
Mailing Address - Phone:620-879-2622
Mailing Address - Fax:620-879-5821
Practice Address - Street 1:101 S MCGEE ST
Practice Address - Street 2:
Practice Address - City:CANEY
Practice Address - State:KS
Practice Address - Zip Code:67333-2140
Practice Address - Country:US
Practice Address - Phone:620-879-2622
Practice Address - Fax:620-879-5821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS47741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty