Provider Demographics
NPI:1336989086
Name:MASCARO, CHASE (DDS)
Entity type:Individual
Prefix:DR
First Name:CHASE
Middle Name:
Last Name:MASCARO
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 1:5266 SARATOGA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-4109
Mailing Address - Country:US
Mailing Address - Phone:985-288-9137
Mailing Address - Fax:
Practice Address - Street 1:665 S PEAR ORCHARD RD
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4861
Practice Address - Country:US
Practice Address - Phone:601-206-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4442-241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice