Active NPI
Derek Deshan Mason, DDS
- Pediatric Dentistry
- Hiram, GA
National Provider Identifier
1679566475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DN012710
- Practice address
- 126 Enterprise Path
Hiram, GA 30141-2656 - Phone
- (770) 439-2550
- Fax
- (770) 439-2141
- NPI assigned
- Aug 26, 2005
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DN012710 | GA | Primary |
Addresses
Primary practice location
126 Enterprise Path
Hiram, GA 30141-2656
Mailing address
126 Enterprise Path
Suite #106
Hiram, GA 30141
Phone (770) 832-1376
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 |
|---|---|---|---|
| DN012710 | GA | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carrollton Family Dentistry | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Carrollton, GA
- NPI 1003968496
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350345600000",
"number": "1679566475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "126 ENTERPRISE PATH",
"address_2": "SUITE #106",
"city": "HIRAM",
"state": "GA",
"postal_code": "30141",
"telephone_number": "770-832-1376",
"fax_number": "770-832-1487"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "126 ENTERPRISE PATH",
"city": "HIRAM",
"state": "GA",
"postal_code": "301412656",
"telephone_number": "770-439-2550",
"fax_number": "770-439-2141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASON",
"first_name": "DEREK",
"middle_name": "DESHAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-26",
"last_updated": "2012-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "GA",
"license": "DN012710",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hiram, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.