Provider Demographics
NPI:1639458730
Name:MASTER, HIRAN
Entity type:Individual
Prefix:
First Name:HIRAN
Middle Name:
Last Name:MASTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8206 PHILIPS HWY UNIT 21
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-1246
Mailing Address - Country:US
Mailing Address - Phone:904-448-6122
Mailing Address - Fax:904-448-6108
Practice Address - Street 1:8206 PHILIPS HWY UNIT 21
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1246
Practice Address - Country:US
Practice Address - Phone:904-448-6122
Practice Address - Fax:904-448-6108
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19398122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist