Provider Demographics
NPI:1831270081
Name:CARLE W. MASON DDS PA
Entity type:Organization
Organization Name:CARLE W. MASON DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLE
Authorized Official - Middle Name:WOODRUFF
Authorized Official - Last Name:MASON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-291-6313
Mailing Address - Street 1:603 NASH ST W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3059
Mailing Address - Country:US
Mailing Address - Phone:252-291-6313
Mailing Address - Fax:252-291-0391
Practice Address - Street 1:603 NASH ST W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3059
Practice Address - Country:US
Practice Address - Phone:252-291-6313
Practice Address - Fax:252-291-0391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3115261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8995485Medicaid