Provider Demographics
NPI:1497064596
Name:MASTERS, KATIE REBECCA (DMD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:REBECCA
Last Name:MASTERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9940 PENDLETON PIKE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-2823
Mailing Address - Country:US
Mailing Address - Phone:317-541-1900
Mailing Address - Fax:866-803-4943
Practice Address - Street 1:9940 PENDLETON PIKE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-2823
Practice Address - Country:US
Practice Address - Phone:317-541-1900
Practice Address - Fax:317-578-8935
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011540A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice