Active NPI
Mason Matthew Luedeker, DDS
- Dentist
- Granbury, TX
National Provider Identifier
1972097533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 34174
- Practice address
- 304 Lantana Dr
Granbury, TX 76049-1181 - Phone
- (817) 279-2321
- NPI assigned
- Jun 18, 2018
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 34174 | TX | Primary |
Addresses
Primary practice location
304 Lantana Dr
Granbury, TX 76049-1181
Mailing address
304 Lantana Dr
Granbury, TX 76049-1181
Phone (817) 279-2321
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 |
|---|---|---|---|
| 34174 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529280000000",
"number": "1972097533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "304 LANTANA DR",
"city": "GRANBURY",
"state": "TX",
"postal_code": "760491181",
"telephone_number": "817-279-2321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "304 LANTANA DR",
"city": "GRANBURY",
"state": "TX",
"postal_code": "760491181",
"telephone_number": "817-279-2321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUEDEKER",
"first_name": "MASON",
"middle_name": "MATTHEW",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-06-18",
"last_updated": "2018-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "34174",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Granbury, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.