Provider Demographics
NPI:1326242157
Name:MASTERS, JACOB LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:LEE
Last Name:MASTERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 US HIGHWAY 31 S
Mailing Address - Street 2:STE 1
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-3582
Mailing Address - Country:US
Mailing Address - Phone:317-881-2500
Mailing Address - Fax:
Practice Address - Street 1:191 US HIGHWAY 31 S
Practice Address - Street 2:STE 1
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-3582
Practice Address - Country:US
Practice Address - Phone:317-881-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011008A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist