Provider Demographics
NPI:1144346834
Name:MASON, JOE L JR (DMD)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:L
Last Name:MASON
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JOE
Other - Middle Name:L
Other - Last Name:MASON
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DMD, PA
Mailing Address - Street 1:10052 LEGOLAS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6985
Mailing Address - Country:US
Mailing Address - Phone:828-226-4691
Mailing Address - Fax:828-615-1244
Practice Address - Street 1:10052 LEGOLAS LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-6985
Practice Address - Country:US
Practice Address - Phone:828-226-4691
Practice Address - Fax:828-615-1244
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice