Provider Demographics
NPI:1407408222
Name:EFTEKHARI, TALA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TALA
Middle Name:
Last Name:EFTEKHARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10747 WILSHIRE BLVD APT 1308
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4409
Mailing Address - Country:US
Mailing Address - Phone:813-625-4147
Mailing Address - Fax:
Practice Address - Street 1:4955 VAN NUYS BLVD STE 716
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1843
Practice Address - Country:US
Practice Address - Phone:818-616-3305
Practice Address - Fax:818-646-0393
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103879122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist