Healthcare Provider Details

I. General information

NPI: 1568510329
Provider Name (Legal Business Name): MASON BRADLEY YEARY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 VILLAGE CREEK DR #1100
PLANO TX
75093-4467
US

IV. Provider business mailing address

1312 VILLAGE CREEK DR #1100
PLANO TX
75093-4467
US

V. Phone/Fax

Practice location:
  • Phone: 972-231-7216
  • Fax: 972-234-0390
Mailing address:
  • Phone: 972-231-7216
  • Fax: 972-234-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14381
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: