Provider Demographics
NPI:1790863868
Name:MASTERS, LANCE B (DMD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:B
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 1:929 RUTHERFORD RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-3802
Mailing Address - Country:US
Mailing Address - Phone:864-877-8008
Mailing Address - Fax:864-877-8082
Practice Address - Street 1:305 BENNETT CENTER DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1259
Practice Address - Country:US
Practice Address - Phone:864-877-8008
Practice Address - Fax:864-877-8082
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ30609Medicaid