Provider Demographics
NPI:1013958149
Name:MASON, JOHN CONLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CONLEY
Last Name:MASON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4585 N HIGHWAY 7 STE 13
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909-8202
Mailing Address - Country:US
Mailing Address - Phone:501-984-5177
Mailing Address - Fax:501-984-6350
Practice Address - Street 1:4585 N HIGHWAY 7
Practice Address - Street 2:SUITE 13
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909
Practice Address - Country:US
Practice Address - Phone:501-984-5177
Practice Address - Fax:501-984-6350
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR33881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152459631Medicaid
AR152459631Medicaid