Healthcare Provider Details

I. General information

NPI: 1710745757
Provider Name (Legal Business Name): MASON WESTON WELCH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 E BROWN RD STE 102
MESA AZ
85207-4351
US

IV. Provider business mailing address

20606 E AVENIDA DEL VALLE
QUEEN CREEK AZ
85142-0229
US

V. Phone/Fax

Practice location:
  • Phone: 480-565-8555
  • Fax:
Mailing address:
  • Phone: 480-459-0415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD012291
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: