Active NPI
Mason Weston Welch, DDS
- Pediatric Dentistry
- Augusta, GA
National Provider Identifier
1710745757
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- D012291
- Practice address
- 1120 15TH St # Gc5114
Augusta, GA 30912-0004 - Phone
- (480) 938-9387
- NPI assigned
- Mar 12, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 | D012291 | AZ | Primary |
Addresses
Primary practice location
1120 15TH St # Gc5114
Augusta, GA 30912-0004
Mailing address
2083 E Walnut CT
Gilbert, AZ 85298-6109
Phone (480) 459-0415
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 |
|---|---|---|---|
| D012291 | AZ | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784160000000",
"number": "1710745757",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2083 E WALNUT CT",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852986109",
"telephone_number": "480-459-0415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 15TH ST # GC5114",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309120004",
"telephone_number": "480-938-9387"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELCH",
"first_name": "MASON",
"middle_name": "WESTON",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-03-12",
"last_updated": "2026-07-16",
"certification_date": "2026-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "AZ",
"license": "D012291",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.