Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Southlake Plastic Surgery

Organization Oral & Maxillofacial Surgery (D.M.D.) · NPI 1255519344

Southlake Plastic Surgery is an Oral & Maxillofacial Surgery (D.M.D.) in Southlake, Texas. Licensed in Texas. Registered with an NPI since 2008.

Licensed in
TX
In the registry since
2008
Specialties on file
2

Practice location Address checks out

900 E Southlake Blvd Ste 100
Southlake, TX 76092-6375
Phone: (817) 442-8900
Fax: (817) 488-2490
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Plastic Surgery Physician (primary) Taxonomy 208200000X
Oral & Maxillofacial Surgery (D.M.D.) Taxonomy 204E00000X · Licence J4330 (TX)

Record details

NPI number1255519344
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mark Mason — Owner · (817) 442-8900
NPI enumeratedJanuary 31, 2008
Last updated in NPPESJanuary 31, 2008
Mailing address900 E Southlake Blvd, Ste 100, Southlake, TX 76092-6375

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