Provider Demographics
NPI:1235107079
Name:UPLAND DENTAL PRACTICE
Entity Type:Organization
Organization Name:UPLAND DENTAL PRACTICE
Other - Org Name:UPLAND DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:
Authorized Official - Last Name:EFTEKHARI
Authorized Official - Suffix:
Authorized Official - Credentials:D D S
Authorized Official - Phone:909-920-6000
Mailing Address - Street 1:270 E 7TH ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6602
Mailing Address - Country:US
Mailing Address - Phone:909-920-6000
Mailing Address - Fax:909-985-6070
Practice Address - Street 1:270 E 7TH ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6602
Practice Address - Country:US
Practice Address - Phone:909-920-6000
Practice Address - Fax:909-985-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty