Provider Demographics
NPI:1063628816
Name:EFTEKHARI, TANDIS (DMD)
Entity Type:Individual
Prefix:
First Name:TANDIS
Middle Name:
Last Name:EFTEKHARI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 SAN JOAQUIN HILLS RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6507
Mailing Address - Country:US
Mailing Address - Phone:949-721-1730
Mailing Address - Fax:949-721-1709
Practice Address - Street 1:2105 SAN JOAQUIN HILLS RD
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6507
Practice Address - Country:US
Practice Address - Phone:949-721-1730
Practice Address - Fax:949-721-1709
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52048122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist