Provider Demographics
NPI:1265840961
Name:MASTER DENTAL PA
Entity Type:Organization
Organization Name:MASTER DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-795-7133
Mailing Address - Street 1:1035 S STATE ROAD 7
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6134
Mailing Address - Country:US
Mailing Address - Phone:561-795-7133
Mailing Address - Fax:561-795-7670
Practice Address - Street 1:1035 S STATE ROAD 7
Practice Address - Street 2:SUITE 310
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6134
Practice Address - Country:US
Practice Address - Phone:561-795-7133
Practice Address - Fax:561-795-7670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN165711223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty