Healthcare Provider Details

I. General information

NPI: 1932317922
Provider Name (Legal Business Name): JODI EVE MASON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODI EVE FAIR DMD

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 RIVERSIDE AVE SUITE 101
JACKSONVILLE FL
32204-4443
US

IV. Provider business mailing address

2008 RIVERSIDE AVE SUITE 101
JACKSONVILLE FL
32204-4443
US

V. Phone/Fax

Practice location:
  • Phone: 904-372-3260
  • Fax: 904-385-3704
Mailing address:
  • Phone: 904-372-3260
  • Fax: 904-385-3704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN17658
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number24122
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: