Provider Demographics
NPI:1184882128
Name:MASON, SAMUEL L (DDS)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:L
Last Name:MASON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:SAMUEL
Other - Middle Name:LESLIE
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1704 MILITARY PKWY
Mailing Address - Street 2:STE 700
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-3673
Mailing Address - Country:US
Mailing Address - Phone:972-288-7197
Mailing Address - Fax:972-288-5364
Practice Address - Street 1:1704 MILITARY PKWY
Practice Address - Street 2:STE 700
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-3673
Practice Address - Country:US
Practice Address - Phone:972-288-7197
Practice Address - Fax:972-288-5364
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist