Provider Demographics
NPI:1144483348
Name:MASON, ROBERT L (DDS, PA)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:MASON
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4474122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist