Provider Demographics
NPI:1922985688
Name:TAYLOR, MASON (DDS)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:
Last Name:TAYLOR
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 1:509 OLDE WATERFORD WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4171
Mailing Address - Country:US
Mailing Address - Phone:509-438-8369
Mailing Address - Fax:
Practice Address - Street 1:509 OLDE WATERFORD WAY STE 300
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4171
Practice Address - Country:US
Practice Address - Phone:910-383-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist