MEDICARE: DR. JODI EVE MASON DMD

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	1223P0221X	Pediatric Dentistry	DN17658	FL
2	1223P0221X	Pediatric Dentistry	24122	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932317922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JODI EVE MASON DMD

Provider Business Mailing Address
First Line	:	2008 RIVERSIDE AVE
Second Line	:	SUITE 101
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4443
Country	:	US
Telephone Number	:	904-372-3260
Fax Number	:	904-385-3704

Provider Business Practice Location Address
First Line	:	2008 RIVERSIDE AVE
Second Line	:	SUITE 101
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4443
Country	:	US
Telephone Number	:	904-372-3260
Fax Number	:	904-385-3704

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	10/09/2024

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