Provider Demographics
NPI:1629419460
Name:MASTERS, JACOB MATTHEW ESHAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:MATTHEW ESHAM
Last Name:MASTERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 LAFOLLETTE STA S
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9772
Mailing Address - Country:US
Mailing Address - Phone:812-923-1000
Mailing Address - Fax:
Practice Address - Street 1:104 LAFOLLETTE STA S
Practice Address - Street 2:
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119-9772
Practice Address - Country:US
Practice Address - Phone:812-923-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012018A1223G0001X
KY93041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice