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NPI Code Detail

MEDICARE: DR. JAMES L MAST DDS

MEDICARE:  DR. JAMES L MAST  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
11223G0001XGeneral Practice Dentistry1905AZ

General Provider Information

NPI Number : 1689675571
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES L MAST DDS
Provider Business Mailing Address
First Line : 3011 N WEST ST
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-3444
Country : US
Telephone Number : 928-774-2997
Fax Number : 928-556-9545
Provider Business Practice Location Address
First Line : 3011 N WEST ST
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-3444
Country : US
Telephone Number : 928-774-2997
Fax Number : 928-556-9545
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 07/08/2007

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