Masters Family Dentistry of Southport

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12011008A Issued in IN

Legal business name

MASTERS FAMILY DENTISTRY OF SOUTHPORT

Doing business as

Masters Family Dentistry

Practice address

5170 Commerce Cir
Indianapolis, IN 46237-9744

Phone

(317) 881-2500

Fax

(317) 881-3308

NPI assigned

Feb 17, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jacob Lee Masters, DDS

Title

Owner

Phone

(317) 881-2500

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Masters Family Dentistry Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329436800000",
    "number": "1578836821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5170 COMMERCE CIR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462379744",
            "telephone_number": "317-881-2500",
            "fax_number": "317-881-3308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5170 COMMERCE CIR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462379744",
            "telephone_number": "317-881-2500",
            "fax_number": "317-881-3308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASTERS FAMILY DENTISTRY OF SOUTHPORT",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-17",
        "last_updated": "2012-02-17",
        "status": "A",
        "authorized_official_last_name": "MASTERS",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-881-2500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12011008A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200863620A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Masters Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jesse Mast
• Tyler Masten
• Kristen Master, FNP-C
• Master's Touch Counseling Services. LLC
• Mastering Adaption & Developement Corp
• Brian Joseph Masters
• Jenna Masters
• Katie Rebecca Masters, DMD
• Reid Masterson, MD
• Timothy A Masterson, MD

• General Practice Dentistry in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.