Provider Demographics
NPI:1487049219
Name:MINER, MASON (DDS)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:
Last Name:MINER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 SUTTLE ST UNIT H
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-6829
Mailing Address - Country:US
Mailing Address - Phone:970-247-2677
Mailing Address - Fax:970-382-9581
Practice Address - Street 1:72 SUTTLE ST UNIT H
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-6829
Practice Address - Country:US
Practice Address - Phone:970-247-2677
Practice Address - Fax:970-382-9581
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86891223G0001X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies