Provider Demographics
NPI:1700044971
Name:MASTERS, ATUL M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ATUL
Middle Name:M
Last Name:MASTERS
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 1:1612 NW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76164-6843
Mailing Address - Country:US
Mailing Address - Phone:817-625-2636
Mailing Address - Fax:817-625-2276
Practice Address - Street 1:1612 NW 28TH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76164-6843
Practice Address - Country:US
Practice Address - Phone:817-625-2636
Practice Address - Fax:817-625-2276
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091167902Medicaid
TX091167903Medicaid
TX091167901Medicaid