Provider Demographics
NPI:1316180821
Name:EFTEKHARI, SIAVASH (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:SIAVASH
Middle Name:
Last Name:EFTEKHARI
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 WEST LEBANON RD.
Mailing Address - Street 2:SUITE 128
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75036
Mailing Address - Country:US
Mailing Address - Phone:817-349-9122
Mailing Address - Fax:817-500-5032
Practice Address - Street 1:255 WEST LEBANON RD.
Practice Address - Street 2:SUITE 128
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036
Practice Address - Country:US
Practice Address - Phone:817-349-9122
Practice Address - Fax:817-500-5032
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ35072086S0122X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery