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Organization
MASTERS FAMILY DENTISTRY OF SOUTHPORT
Active
Organization
MASTERS FAMILY DENTISTRY OF SOUTHPORT
Active
Other names
Masters Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB LEE MASTERS DDS (OWNER)
(317) 881-2500
Entity
Organization
Contact information
Practice address
5170 COMMERCE CIR, INDIANAPOLIS, IN 46237-9744
(317) 881-2500
(317) 881-3308
Mailing address
5170 COMMERCE CIR, INDIANAPOLIS, IN 46237-9744
(317) 881-2500
(317) 881-3308
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12011008A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200863620A
—
IN
Enumeration date
02/17/2012
Last updated
02/17/2012
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