Provider Demographics
NPI:1124130554
Name:MASON FAMILY DENTISTRY, P.C.
Entity type:Organization
Organization Name:MASON FAMILY DENTISTRY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-676-3770
Mailing Address - Street 1:624 S CEDAR ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-1589
Mailing Address - Country:US
Mailing Address - Phone:517-676-3770
Mailing Address - Fax:517-676-3771
Practice Address - Street 1:624 S CEDAR ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-1589
Practice Address - Country:US
Practice Address - Phone:517-676-3770
Practice Address - Fax:517-676-3771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17763261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental