Provider Demographics
NPI:1992871909
Name:MASTIN, JESSIE BRYAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:BRYAN
Last Name:MASTIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 LITTLE BEAR CREEK POINT SUITE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904
Mailing Address - Country:US
Mailing Address - Phone:719-633-2828
Mailing Address - Fax:719-633-7461
Practice Address - Street 1:1455 LITTLE BEAR CREEK PT STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-6834
Practice Address - Country:US
Practice Address - Phone:719-633-2828
Practice Address - Fax:719-633-7461
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist