MEDICARE: JAMES L. MAST, DDS, PC

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	1223G0001X	General Practice Dentistry	1905	AZ

General Provider Information

NPI Number	:	1548394976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES L. MAST, DDS, PC

Provider Business Mailing Address
First Line	:	3011 N WEST ST
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-3444
Country	:	US
Telephone Number	:	928-774-2997
Fax Number	:	928-556-9545

Provider Business Practice Location Address
First Line	:	3011 N WEST ST
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-3444
Country	:	US
Telephone Number	:	928-774-2997
Fax Number	:	928-556-9545

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES LEE MAST
Credential	:	DDS
Telephone Number	:	928-774-2997

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/22/2020

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