MEDICARE: DR. MASON BRADLEY YEARY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	14381	TX

General Provider Information

NPI Number	:	1568510329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MASON BRADLEY YEARY DDS

Provider Business Mailing Address
First Line	:	1312 VILLAGE CREEK DR
Second Line	:	#1100
City	:	PLANO
State	:	TX
Zip	:	75093-4467
Country	:	US
Telephone Number	:	972-231-7216
Fax Number	:	972-234-0390

Provider Business Practice Location Address
First Line	:	1312 VILLAGE CREEK DR
Second Line	:	#1100
City	:	PLANO
State	:	TX
Zip	:	75093-4467
Country	:	US
Telephone Number	:	972-231-7216
Fax Number	:	972-234-0390

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	01/10/2017

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