Healthcare Provider Details

I. General information

NPI: 1588646798
Provider Name (Legal Business Name): JAMES FREDRICK MASON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 BUCKWALTER PLACE BLVD
BLUFFTON SC
29910
US

IV. Provider business mailing address

337 BUCKWALTER PLACE BLVD
BLUFFTON SC
29910-5175
US

V. Phone/Fax

Practice location:
  • Phone: 843-815-6000
  • Fax:
Mailing address:
  • Phone: 843-815-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number9008
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: