Healthcare Provider Details

I. General information

NPI: 1063266997
Provider Name (Legal Business Name): MASON BART SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

772 N DIXIE DR STE 101
ST GEORGE UT
84770-7444
US

IV. Provider business mailing address

772 N DIXIE DR STE 101
ST GEORGE UT
84770-7444
US

V. Phone/Fax

Practice location:
  • Phone: 435-628-0511
  • Fax:
Mailing address:
  • Phone: 436-628-0511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberS6-250C
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number14251849-9925
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: