Active NPI
John Michael Masterson Jr., DMD
- General Practice Dentistry
- Palmyra, NY
National Provider Identifier
1184767873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 032505-1
- Practice address
- 402 W Main St
Palmyra, NY 14522-1004 - Phone
- (315) 597-4581
- NPI assigned
- Feb 14, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 032505-1 | NY | Primary |
Addresses
Primary practice location
402 W Main St
Palmyra, NY 14522-1004
Mailing address
45 Waterford Way
Fairport, NY 14450-9750
Phone (585) 223-3149
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 032505-1 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1184767873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45 WATERFORD WAY",
"city": "FAIRPORT",
"state": "NY",
"postal_code": "144509750",
"telephone_number": "585-223-3149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "402 W MAIN ST",
"city": "PALMYRA",
"state": "NY",
"postal_code": "145221004",
"telephone_number": "315-597-4581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASTERSON",
"first_name": "JOHN",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "032505-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palmyra, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.