Provider Demographics
NPI:1336281062
Name:MASTERS, ANTONETTE PADUA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTONETTE
Middle Name:PADUA
Last Name:MASTERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18251 ROSCOE BLVD.
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325
Mailing Address - Country:US
Mailing Address - Phone:818-700-1247
Mailing Address - Fax:
Practice Address - Street 1:18251 ROSCOE BLVD.
Practice Address - Street 2:SUITE 201A
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325
Practice Address - Country:US
Practice Address - Phone:818-700-1247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist