MEDICARE: ANGELA MASTERS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	39608	TX
2	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1043169956	OTHER	TX	NPI2

General Provider Information

NPI Number	:	1659075398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MASTERS DDS

Provider Business Mailing Address
First Line	:	2630 S CARRIER PKWY STE B
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-5000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2630 S CARRIER PKWY STE B
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-5000
Country	:	US
Telephone Number	:	972-641-9888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2023
Last Update Date	:	01/23/2026

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