Active NPI
Mason James Proctor, DDS
- General Practice Dentistry
- Burleson, TX
National Provider Identifier
1083458491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 40651
- Practice address
- 2701 SW Wilshire Blvd
Burleson, TX 76028-6307 - Phone
- (817) 709-6732
- NPI assigned
- Jun 20, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 40651 | TX | Primary |
Addresses
Primary practice location
2701 SW Wilshire Blvd
Burleson, TX 76028-6307
Mailing address
2701 SW Wilshire Blvd
Burleson, TX 76028-6307
Phone (936) 585-2778
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40651 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718841600000",
"number": "1083458491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2701 SW WILSHIRE BLVD",
"city": "BURLESON",
"state": "TX",
"postal_code": "760286307",
"telephone_number": "936-585-2778"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2701 SW WILSHIRE BLVD",
"city": "BURLESON",
"state": "TX",
"postal_code": "760286307",
"telephone_number": "817-709-6732"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROCTOR",
"first_name": "MASON",
"middle_name": "JAMES",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-06-20",
"last_updated": "2024-06-20",
"certification_date": "2024-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "40651",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burleson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.