Healthcare Provider Details

I. General information

NPI: 1982793469
Provider Name (Legal Business Name): LISA B. MASTERS DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 BLANCO RD STE 100
SAN ANTONIO TX
78216-4361
US

IV. Provider business mailing address

7400 BLANCO RD., STE. #100 MASTERS DENTAL GROUP
SAN ANTONIO TX
78216
US

V. Phone/Fax

Practice location:
  • Phone: 210-349-4424
  • Fax: 210-340-8156
Mailing address:
  • Phone: 210-349-4424
  • Fax: 210-340-8156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number16857
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: