Provider Demographics
NPI:1457660151
Name:EFTEKHARI, SAMIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMIN
Middle Name:
Last Name:EFTEKHARI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MICHELANGELO
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1476
Mailing Address - Country:US
Mailing Address - Phone:305-609-4726
Mailing Address - Fax:
Practice Address - Street 1:13431 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-3435
Practice Address - Country:US
Practice Address - Phone:562-946-2838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61253122300000X
VA0401412991122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist