Healthcare Provider Details

I. General information

NPI: 1831219070
Provider Name (Legal Business Name): JANICE M MASTER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 SE FEDERAL HWY
STUART FL
34994-5738
US

IV. Provider business mailing address

610 CLEMATIS ST APT. 717
WEST PALM BEACH FL
33401-5398
US

V. Phone/Fax

Practice location:
  • Phone: 772-219-2224
  • Fax: 772-219-2216
Mailing address:
  • Phone: 561-277-7258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN16571
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: