MEDICARE: MASON JOHN LUCAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist		TX

General Provider Information

NPI Number	:	1174493142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASON JOHN LUCAS

Provider Business Mailing Address
First Line	:	4070 STANLEY RD STE 401
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78234-2714
Country	:	US
Telephone Number	:	406-475-5168
Fax Number	:

Provider Business Practice Location Address
First Line	:	4070 STANLEY RD STE 401
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78234-2714
Country	:	US
Telephone Number	:	406-475-5168
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2025
Last Update Date	:	11/06/2025

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Directions to “ MASON JOHN LUCAS ” Practice Location

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