Provider Demographics
NPI:1538051685
Name:MASTEN, JEREMY (DMD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:MASTEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 KALAKAUA AVE APT 311
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-2434
Mailing Address - Country:US
Mailing Address - Phone:202-351-9736
Mailing Address - Fax:
Practice Address - Street 1:222 RICK FRANCIS ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2817
Practice Address - Country:US
Practice Address - Phone:915-215-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI0122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist