Provider Demographics
NPI:1730235987
Name:MASON, SCOTT ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALAN
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 1:801 W WALL ST
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5149
Mailing Address - Country:US
Mailing Address - Phone:817-481-4717
Mailing Address - Fax:817-488-8335
Practice Address - Street 1:801 W WALL ST
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5149
Practice Address - Country:US
Practice Address - Phone:817-481-4717
Practice Address - Fax:817-488-8335
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752737777OtherDENTAL OFFICE