Provider Demographics
NPI:1659345833
Name:LEMASTERS, GRANT DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:DAVID
Last Name:LEMASTERS
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 1:4273 ETHELDA PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4823
Mailing Address - Country:US
Mailing Address - Phone:619-524-4005
Mailing Address - Fax:
Practice Address - Street 1:4273 ETHELDA PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4823
Practice Address - Country:US
Practice Address - Phone:619-524-4005
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA522961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice