Healthcare Provider Details

I. General information

NPI: 1245455914
Provider Name (Legal Business Name): WILLIAM HOWARD MASON II DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MAIN ST
SUMMERSVILLE WV
26651-1343
US

IV. Provider business mailing address

10003 WEBSTER RD
CAMDEN ON GAULEY WV
26208-7713
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-1663
  • Fax: 304-872-1804
Mailing address:
  • Phone: 304-226-5725
  • Fax: 304-226-3274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3677
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: