Provider Demographics
NPI:1215232046
Name:MASON, MILES ALEXANDER (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:MILES
Middle Name:ALEXANDER
Last Name:MASON
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28223 WHISPERING MAPLE WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-3777
Mailing Address - Country:US
Mailing Address - Phone:936-718-1415
Mailing Address - Fax:
Practice Address - Street 1:1001 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-3241
Practice Address - Country:US
Practice Address - Phone:281-363-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26121122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist