Active NPI
Jessie Bryan Mastin, DDS
- Dentist
- Colorado Springs, CO
National Provider Identifier
1992871909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 7300
- Practice address
- 1455 Little Bear Creek PT Ste 100
Colorado Springs, CO 80904-6834 - Phone
- (719) 633-2828
- Fax
- (719) 633-7461
- NPI assigned
- Nov 28, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 7300 | CO | Primary |
Addresses
Primary practice location
1455 Little Bear Creek PT Ste 100
Colorado Springs, CO 80904-6834
Mailing address
1544 Little Bear Creek Point Suite 100
Colorado Springs, CO 80904
Phone (719) 633-2828
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 |
|---|---|---|---|
| 7300 | CO | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661904000000",
"number": "1992871909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1544 LITTLE BEAR CREEK POINT SUITE 100",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "80904",
"telephone_number": "719-633-2828",
"fax_number": "719-633-7461"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1455 LITTLE BEAR CREEK PT STE 100",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809046834",
"telephone_number": "719-633-2828",
"fax_number": "719-633-7461"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASTIN",
"first_name": "JESSIE",
"middle_name": "BRYAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-28",
"last_updated": "2022-08-31",
"certification_date": "2022-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "7300",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.