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General NPI Number Information
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NPI Number | 1700446044
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Entity Type | Individual
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Provider Name | MARK MAST DMD
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Gender | Male
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 1261 DIVISION HWY
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City | EPHRATA
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State | PA
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Zip | 17522-8822
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Country | US
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Telephone | 717-738-1353
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 LITITZ PIKE
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City | LANCASTER
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State | PA
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Zip | 17601-3802
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Country | US
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Telephone | 540-820-8779
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS042232
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License Number State | PA
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