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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