Provider Demographics
NPI:1982793469
Name:MASTERS, LISA B (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:B
Last Name:MASTERS
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 BLANCO RD., STE. #100
Mailing Address - Street 2:MASTERS DENTAL GROUP
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216
Mailing Address - Country:US
Mailing Address - Phone:210-349-4424
Mailing Address - Fax:210-340-8156
Practice Address - Street 1:7400 BLANCO RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4361
Practice Address - Country:US
Practice Address - Phone:210-349-4424
Practice Address - Fax:210-340-8156
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168571223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
86D951OtherBLUE CROSS BLUE SHIELD