MEDICARE: DR. LISA B. MASTERS DDS, MS

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	1223P0300X	Periodontics	16857	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86D951	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1982793469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA B. MASTERS DDS, MS

Provider Business Mailing Address
First Line	:	7400 BLANCO RD., STE. #100
Second Line	:	MASTERS DENTAL GROUP
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216
Country	:	US
Telephone Number	:	210-349-4424
Fax Number	:	210-340-8156

Provider Business Practice Location Address
First Line	:	7400 BLANCO RD STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-4361
Country	:	US
Telephone Number	:	210-349-4424
Fax Number	:	210-340-8156

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	11/21/2022

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