Provider Demographics
NPI:1689878415
Name:MASTERS FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:MASTERS FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MASTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-881-2500
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011008A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental